Abstract
Adolescents living with human immunodeficiency virus (HIV) (ALHIV) globally, report worse treatment outcomes compared to adults and children on antiretroviral therapy (ART). We conducted a photovoice study with eighteen ALHIV to explore experiences and challenges of being on ART, and individual interviews with 5 health workers to describe the challenges in treating ALHIV. The facility implemented the Family club intervention to facilitate caregivers (parent/guardians) supporting ALHIV on treatment. The health workers revealed that “disclosing HIV status” to children was the biggest challenge for caregivers and health workers. Participating ALHIV reported that family support and having a positive mentality were instrumental for continued treatment adherence. However, disclosure of HIV status to friends remained a challenge due to pervasive community stigma. Treatment fatigue and side-effects were also barriers to adherence. Family support was instrumental in facilitating adherence support for ALHIV. However, this (intervention) should include peer support to improve positive mental well-being in ALHIV.
Highlights
The increased availability of antiretroviral therapy (ART) combined with the scaling up of health care services and programmes aimed at supporting adherence to treatment has increased the life expectancy of people living with human immunodeficiency virus (HIV) (PLHIV), including perinatally infected children who are surviving into adolescence.[1,2]
Other themes reflect other challenges experienced by health workers as well as adolescents living with HIV (ALHIV) experiences of Family Club, ROTF Clinic, Disclosure, Motivation and Challenges to Treatment Adherence and Family Support
The findings from this case study provide valuable insights regarding the treatment experiences and services ALHIV receive at a public health care facility in the Western Cape province of South Africa
Summary
The increased availability of antiretroviral therapy (ART) combined with the scaling up of health care services and programmes aimed at supporting adherence to treatment has increased the life expectancy of people living with human immunodeficiency virus (HIV) (PLHIV), including perinatally infected children who are surviving into adolescence.[1,2] The increased survival rates of perinatally infected children along with the growing number of behaviorally infected adolescents have resulted in adolescents being identified as the fastest-growing population of PLHIV. It is estimated that there has been a 45% increase in AIDS-related deaths among adolescents between 2005 and 2015.4 This is of great concern, as it stands in contrast to the decrease in AIDS-related deaths reported for all other age groups.[5] The increase in AIDS-related deaths among ALHIV suggests lapses in treatment and successful engagement Evidence suggests that this lapse in treatment may be associated with the type of care and the quality of support that ALHIV receive.[6] Adolescence is a unique developmental period in which individuals experience significant physical, psychological and social changes.[7,8,9] Our report from an exploratory study of ALHIV on ART in a low socioeconomic setting in Cape Town revealed that; school versus health facility conflicts, negative household dynamics and finding the health facility as an unfriendly place, as reported barriers to adherence.[10] the World Health Organization (WHO) recommended that public health care facilities establish adolescent-friendly health services which include age-appropriate treatment programmes to provide psychosocial support, sexual and reproductive health
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