Social-support needs among adolescents living with HIV in transition from pediatric to adult care in Cambodia: findings from a cross-sectional study

Graham Toth,Chanrith Ngin,Gitau Mburu,Sovannary Tuot,Siyan Yi,Pheak Chhoun,Vohith Khol

doi:10.1186/s12981-018-0195-x

Abstract

BackgroundUnderstanding the circumstances of adolescents living with HIV is critical in designing adolescent-friendly services that will facilitate successful transition from pediatric to adult care. This study describes access, utilization and ongoing social support needs among adolescents living with HIV aged 15–17 in transition from pediatric to adult HIV care in Cambodia.MethodsA cross-sectional study was conducted among 328 adolescents, randomly selected from 11 antiretroviral therapy (ART) clinics across the country. Descriptive analyses were conducted to summarize their characteristics, access to social support and ongoing support needs among male and female adolescents.ResultsMean age of the study participants was 15.8 (SD = 0.8) years. Just over half (55.2%) were male. Most had at least one deceased parent (mother 50.9%; father 60.5%), and majority were living with biological parents (40.8%) or relatives (49.3%). A third came from families with an ID poor card, and 21.0% were working for pay. Almost half (46.6%) reported that their family had received social support for their health care, including food support (76.5%), school allowance (62.1%), transport allowance to ART clinics (53.6%), psychosocial counseling (35.3%), vocational training (22.9%) or home visits (11.1%). Several ongoing social support needs were identified, including ongoing inability to cover health expenses unless they are supported by health insurance or health equity fund (55.0%). In addition, adolescents reported having been asked to come back earlier than their scheduled appointment (13.7%), having had to purchase their own drugs (2.7%), experiencing HIV stigma (32.0%), having been denied housing or food due to HIV (8.2%) or failing to attend school within the past month partly because of HIV (16.8%). Two-thirds did not have access to peer support groups.ConclusionsSocial protection mechanisms are reaching some adolescents in need, while other remain without social support due to discontinuities in health and social care. Multi-sectoral interventions, supporting school attendance, adolescent-friendly clinic scheduling, reductions in child employment, mitigation of HIV-related stigma and strengthening of peer-to-peer support are required to improve coverage of social protection interventions for adolescents in transition.

Highlights

Understanding the circumstances of adolescents living with HIV is critical in designing adolescentfriendly services that will facilitate successful transition from pediatric to adult care
This paper describes utilization and ongoing social support needs among adolescents living with HIV aged 15–17 in transition from pediatric to adult care in Cambodia and discusses the implications of the findings on a successful transition from pediatric to adult HIV care
Given that access to available social protection support was suboptimal, our results argue for adolescent-focused interventions at multiple layers of the sociological context [24] to ensure that every needy adolescent has access to available wrap around services to support successful adolescent transition

Summary

Introduction

Understanding the circumstances of adolescents living with HIV is critical in designing adolescentfriendly services that will facilitate successful transition from pediatric to adult care. This study describes access, utilization and ongoing social support needs among adolescents living with HIV aged 15–17 in transition from pediatric to adult HIV care in Cambodia. Given the dynamic changes during adolescence, studies exploring outcomes of HIV care tend to distinguish adolescents living with HIV from both pediatric and adult populations. Evidence from these studies shows that adolescents’ access and outcomes of care are generally sub-optimal. Exploration of causes and potential solutions to these poor outcomes have generally focused on biomedical and health system solution [15]

Methods

Results

Discussion

Conclusion