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Factors Associated With Nonadherence to Antiretroviral Therapy Among Young People Living With Perinatally Acquired HIV in England. J Assoc Nurses AIDS Care 2021; 31:574-586. [PMID: 32467489 PMCID: PMC7497417 DOI: 10.1097/jnc.0000000000000171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Young people living with perinatally acquired HIV may be at risk of poor adherence to antiretroviral therapy; identification of predictors, using a conceptual framework approach proposed previously by others, is important to identify those at higher risk. In 261 young people with perinatally acquired HIV in England, 70 (27%) reported 3-day nonadherence, 82 (31%) last month nonadherence, and 106 (41%) nonadherence on either measure. Of those reporting nonadherence on both measures, 52% (23/44) had viral load of <50 copies/ml, compared with 88% (127/145) of those reported being fully adherent. In multivariable analysis, young person and medication theme factors were associated with nonadherence. The main predictors of 3-day nonadherence were antiretroviral therapy containing a boosted protease inhibitor and poorer quality of life. Predictors of last month nonadherence were having told more people about one's HIV status, worse self-perception about having HIV, and boosted protease inhibitor-based regimens. The consistency of individual young person and medication factors in predicting nonadherence gives insight into where interventions may best be targeted to improve adherence.
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Ritchwood TD, Malo V, Jones C, Metzger IW, Atujuna M, Marcus R, Conserve DF, Handler L, Bekker LG. Healthcare retention and clinical outcomes among adolescents living with HIV after transition from pediatric to adult care: a systematic review. BMC Public Health 2020; 20:1195. [PMID: 32746881 PMCID: PMC7398377 DOI: 10.1186/s12889-020-09312-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/28/2020] [Indexed: 01/31/2023] Open
Abstract
Background Adolescents living with HIV (ALWH) who transition from pediatric to adult care face several challenges that increase their risk of experiencing treatment interruptions and being lost to HIV care with resultant increased morbidity and mortality. To date, few studies have examined their outcomes post-healthcare transition (HCT), precluding the development and dissemination of evidence-based interventions aimed at retaining ALWH in HIV care both during and after HCT. We conducted a systematic review to synthesize the outcomes of ALWH post-HCT to provide suggestions for future directions. Methods We systematically searched several electronic databases through October 2019 using keywords for HIV, HCT and ALWH. We categorized studies by target population, country (i.e., upper-high income and low-middle income), study design (i.e., descriptive, mixed methods, quantitative), outcomes measured, and follow-up period. Results A total of 24 studies met inclusion criteria. Studies were categorized according to the following HCT outcomes: retention in HIV care post-HCT (n = 13), changes in CD4+ count and viral load post-HCT (n = 16), and mortality among ALWH post-HCT (n = 7). Most studies (n = 11) examining retention in HIV care indicated that more than 70% of ALWH were retained in care 1–2 years post-HCT while the remaining studies (n = 2) reported retention rates less than 55%. While studies indicated that CD4+ counts and viral loads tended to worsen during the first few years post-HCT, these differences were often not statistically significant. Among all ALWH who transitioned to adult care, a small proportion died within their first seven years post-HCT. Among qualitative studies, common themes included transition readiness (n = 6), provider-patient relationship in the adult clinic setting (n = 6), and concern about the adult clinic setting (n = 4). Conclusions Transition outcomes were poorest for ALWH with unsuppressed viremia pre-HCT, suggesting that this subgroup of ALWH may need greater support from their treatment teams and caregivers during and post-HCT to improve clinical outcomes.
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Affiliation(s)
- Tiarney D Ritchwood
- Department of Family Medicine and Community Health, Duke University, 2200 W Main St, Durham, NC, 27705, USA. .,Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Vincenzo Malo
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Cameron Jones
- Department of Public Health Sciences, School of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Isha W Metzger
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, Health Sciences Faculty, University of Cape Town, Institute of Infectious Disease, Cape Town, South Africa
| | - Rebecca Marcus
- Desmond Tutu HIV Centre, Health Sciences Faculty, University of Cape Town, Institute of Infectious Disease, Cape Town, South Africa
| | - Donaldson F Conserve
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lara Handler
- School of Information and Library Science, University of North Carolina, Chapel Hill, NC, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, Health Sciences Faculty, University of Cape Town, Institute of Infectious Disease, Cape Town, South Africa
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