Abstract
ABSTRACTLow ART-adherence amongst adolescents is associated with morbidity, mortality and onward HIV transmission. Reviews find no effective adolescent adherence-promoting interventions. Social protection has demonstrated benefits for adolescents, and could potentially improve ART-adherence. This study examines associations of 10 social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10–19-year-olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa’s Eastern Cape were traced and interviewed in 2014–2015 (n = 1175 eligible). About 90% of the eligible sample was included (n = 1059). Social protection provisions were “cash/cash in kind”: government cash transfers, food security, school fees/materials, school feeding, clothing; and “care”: HIV support group, sports groups, choir/art groups, positive parenting and parental supervision/monitoring. Analyses used multivariate regression, interaction and marginal effects models in SPSS and STATA, controlling for socio-demographic, HIV and healthcare-related covariates. Findings showed 36% self-reported past-week ART non-adherence (<95%). Non-adherence was associated with increased opportunistic infections (p = .005, B .269, SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1–3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR .57, CI .42–.76, p < .001); HIV support group attendance (aOR .60, CI .40–.91, p < .02), and high parental/caregiver supervision (aOR .56, CI .43–.73, p < .001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection 39–41%, with any two social protections, 27–28% and with all three social protections, 18%. These results demonstrate that social protection provisions, particularly combinations of “cash plus care”, may improve adolescent adherence. Through this they have potential to improve survival and wellbeing, to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents.
Highlights
Non-adherence was 54%, with any one protection 39–41%, with any two social protections, 27–28% and with all three social protections, 18%. These results demonstrate that social protection provisions, combinations of “cash plus care”, may improve adolescent adherence
The scale-up of HIV-treatment provides an opportunity for the survival and long-term well-being of the 1.6 million HIV-positive adolescents in Southern Africa (UNAIDS, 2015b)
One thousand fifty-nine antiretroviral therapy (ART)-initiated adolescents were interviewed using clinic sampling with community tracing in a mixed urban, peri-urban and rural health district of the Eastern Cape, South Africa
Summary
The scale-up of HIV-treatment provides an opportunity for the survival and long-term well-being of the 1.6 million HIV-positive adolescents in Southern Africa (UNAIDS, 2015b). AIDS is currently the single greatest cause of death amongst adolescents aged 10–19 in Africa (UNAIDS, 2015a). Studies in the USA and Southern Africa find associations between non-adherence to sexual risk behaviour and mental health distress (Lowenthal et al, 2012; Mellins et al, 2011). Adolescence is a period of social, familial and emotional change. Adolescence is a transitional period in health provisions and practices (Ferrand et al, 2010), as adolescents may move from paediatric to adolescent services, changing from caregiver-mediated to autonomous adherence
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