Young People Living With HIV Research Articles

Access to sexual and reproductive health services among South African young people living with and without HIV during the COVID-19 pandemic

ObjectiveTo examine sexual and reproductive health (SRH) service access among South African young people during the COVID-19 pandemic. Study designWe utilized cross-sectional data collected from February to October 2021 in Cape Town among young people 13–24 years of age living with and without HIV. ResultsTwo hundred and fifteen young people living with HIV (YPLWH) and 320 young people living without HIV were included. Young people reported an unmet need for SRH services during COVID-19, and 28% of YPLWH reported missing an HIV care appointment during the COVID-19 lockdowns. ConclusionsExpanding access to SRH services for young people during disruptive events is critical to reduce disparities in HIV and other SRH outcomes.

Prevalence and risk factors of cardiovascular disease among people living with HIV in the Asia-Pacific region: a systematic review

BackgroundCardiovascular diseases (CVD) due to atherosclerosis have become one of the major causes of death among people living with HIV (PLHIV) since effective antiretroviral therapy (ART) has been available throughout the world. However, the epidemiologic evidence of this problem from the Asia-Pacific region remains unclear. We conducted a systematic review of the situation and risk factors for CVD among PLHIV in countries with the greatest impact of CVD attributable to HIV in the Asia-Pacific region.MethodsA systematic search in PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews databases for articles published before 2019 was conducted. Publications reported situations and risk factors both traditional and HIV-specific for CVD among PLHIV in the region were included. Two reviewers working on duplicate and quality assessments, independently extracted data, and thematically analyzed the data.ResultsAmong PLHIV, the prevalence of subclinical CVD ranged from 10 to 28% and the incidence rate of clinical CVD ranged from 0.37 to 1.17 /100 person-years. Clinical CVD was frequently observed in the early era of the highly active antiretroviral therapy. A higher prevalence of subclinical CVD such as abnormal cIMT and carotid plaques was frequently observed in the PLHIV rather than in the nonHIV population and a high proportion of early onset of CVD was found among young PLHIV adults. The traditional risk factors for CVD such as hypertension, diabetes and smoking behavior were prevalent in both PLHIV and nonHIV populations ranging from 5 to 45%. HIV-specific risk factor, and lower CD4 presented almost twice the significantly increased risks for CVD while the synergistic interaction among traditional risk factors, i.e., diabetes mellitus, dyslipidemia and family history steeply increased the risk for CVD among PLHIV by almost 20 times.ConclusionThe limited existing data suggested the risk of early CVD among PLHIV. We identified the crucial gaps in HIV/CVD work from the Asia-Pacific region and recommended longer prospective studies with larger sample sizes or meta-analyses to better capture CVD risk and interactions of crucial risk factors of this vulnerable population in this region.Registration numberINPLASY202290108 (https://inplasy.com/inplasy-2022-9-0108/).

Challenges in healthcare access for young people living with HIV: A review

Background Young People Living with HIV (YPLH) face numerous obstacles when trying to get medical care. In some parts of the world, AIDS-related mortality, and infection rates among people in this age continue to rise. The main causes of this include infrastructural challenges, concerns about unintentional disclosure and confidentiality, and the still-limited attitudes of healthcare professionals towards these age groups. This review article highlights the key aspects of access-related problems based on a thorough literature search and a synthesis of the available data about the difficulties the YPLH experiences. # Methods We looked through the last 15 years’ worth of English-language studies that were conducted worldwide and published in the databases MEDLINE, PUBMED, MEDILINE, GOOGLE SCHOLAR, COCHRANE, and SCIENCE DIRECT. 35 articles fully meeting the inclusion criteria were included. # Results The literature review identified four overarching themes in terms of accessibility, including financial and insurance-related issues, workforce challenges, lack of knowledge and approachability issues associated with infrastructure and long travel distances. Furthermore, acceptability issues related to stigma, disclosure, discrimination, and low social support. The information was categorized from literature synthesis and was listed under the specific category that were decided earlier while beginning the search. These subcategories defined challenges to young people’s access to HIV healthcare regarding affordability, acceptability, availability and approachability. # Conclusions YPLH encounters a multitude of challenges. These difficulties may be caused by structural reasons like social pressure, personal & societal ignorance about HIV, restricted access to HIV prophylaxis, and regulatory impediments. The findings imply that to facilitate the readily accessible HIV care services for youth it is vital to increase society’s and healthcare professionals’ awareness of HIV at every level.

The sexual and reproductive health needs of young people living with HIV in Gauteng, South Africa.

BackgroundHIV has been the focus of health systems strengthening in South Africa for the past two decades. Despite progress, sexual and reproductive health (SRH) challenges such as contraception, condom usage and HIV disclosure of young people living with HIV (YPLHIV) remain inadequately addressed. Therefore, the purpose of the study was to describe the SRH needs of YPLHIV and make recommendations to address identified gaps.ObjectivesTo explore and describe the SRH needs and potential systemic gaps of YPLHIV with an aim to make recommendations for improvement and contribute to the development of an integrated approach to SRH care in HIV programming.MethodA quantitative cross-sectional research design with purposive sampling was utilised. YPLHIV were recruited from five healthcare facilities in Gauteng, South Africa, for face-to-face interviews.ResultsOne hundred and six YPLHIV with a median age of 18 years were enrolled. A large proportion (57/106; 53.8%) of respondents reported being either single or double orphaned. Sex-related discussions with parents were reported by only 36/106 (34.0%). History of teenage pregnancy was reported in 39/70 (56.0%) of female respondents. A high prevalence of multiple sexual partnerships 41/97 (42.2%) was noted. Consensual partner HIV disclosure was low at 47/97 (48.4%) and the male gender was associated with low 10/35 (28.6%) disclosure of serostatus to sexual partners.ConclusionMultiple SRH needs were identified. Interventions are needed to improve parental guidance on SRH issues, increase contraception knowledge and access, and provide better male-centred care.

Adaptation, acceptability and feasibility of Problem Management Plus (PM+) intervention to promote the mental health of young people living with HIV in Kenya: formative mixed-methods research.

Problem Management Plus (PM+) is a psychological intervention that seeks to address common mental disorders among individuals exposed to adversity. Thus far, the potential for delivering PM+ by mobile phones has not been evaluated. To adapt PM+ for telephone delivery (ten weekly sessions of about 45 min each) and preliminarily evaluate its acceptability and feasibility with young people living with HIV (YLWH) in coastal Kenya. This was a mixed-method formative research. Qualitative data collection included consultations with stakeholders, conducting key informant interviews with HIV care providers and focus group discussions with potential end-users, i.e. YLWH. Moreover, brief exit interviews with recipients of the adapted PM+ were conducted. Quantitative acceptability and feasibility indicators and outcome measures were tracked/assessed during PM+ preliminary implementation involving 70 YLWH. From the qualitative inquiries, the adapted PM+ emerged as contextually appropriate, acceptable and feasible for mobile phone delivery, despite some concerns around missing nonverbal cues and poor network connectivity. High recruitment (85%) and fair programme retention (69%) were observed. Intervention sessions over the telephone lasted 46 min on average (range 42-55 min). Preliminary feasibility data indicated that the adapted PM+ has the potential of reducing common mental disorders among YLWH from the Kenyan coast. PM+ is acceptable and can feasibly be delivered via mobile phone to YLWH in coastal Kenya. This study sets the stage for a future fully powered, randomised controlled trial assessing the efficacy of the adapted PM+ in this or a similar setting.

Development of shortened HIV-related stigma scales for young people living with HIV and young people affected by HIV in India

BackgroundHIV-related stigma is associated with poor quality of life and poor healthcare-seeking behaviours in young people living with HIV (YPLHIV) and young people affected by HIV (YPAHIV). India has an estimated 120,000 YPLHIV and 4 million YPAHIV, but efforts to measure HIV-related stigma in them are sparse, impeded by the lack of measuring instruments. Here, we describe the development of the Pune HIV-Stigma Scale (PHSS) and modified-PHSS to measure HIV-related stigma among YPLHIV and YPAHIV, respectively, in India.MethodsWe used data from a mental health study for YPLHIV and YPAHIV aged 15–25 years, conducted at Byramjee Jeejeebhoy Government Medical College & Sassoon General Hospitals, Pune, India, between August 2018 and June 2021. Findings from multiple confirmatory factor analyses and cognitive interviews guided the development of the 12-item PHSS. The modified-PHSS was developed by confirming the structure of the PHSS for YPAHIV. Convergent validity with Center for Epidemiological Studies Depression (CES-D) and UCLA Loneliness scales was assessed using Spearman’s correlation coefficients.ResultsModel fit indices were good for both the PHSS (χ2 = 65.0, df = 48, p value: 0.052; root mean square error of approximation (RMSEA): 0.054; comparative fit index (CLI): 0.980; Tucker–Lewis index (TLI): 0.972; and standardized root mean square residual (SRMR): 0.067), and the modified-PHSS (χ2 = 56.9, df = 48, p value: 0.176; RMSEA: 0.045; CLI: 0.983; TFI: 0.976, and SRMR: 0.078). Spearman’s correlation coefficients indicated low to moderate convergent validity (ρ: 0.03–0.52) across different subscales of the PHSS and modified-PHSS. Cronbach’s alpha for the PHSS was 0.82 and for the modified-PHSS 0.81.ConclusionWe developed the first scales to measure HIV-related stigma among YPLHIV and YPAHIV in India. These concise scales can facilitate measurement of HIV-related stigma more frequently in research studies. We recommend that they be tested in different Indian languages.

Differences in prevalence and risk factors of non-communicable diseases between young people living with HIV (YLWH) and young general population in Cambodia.

Understanding non-communicable diseases (NCDs) among young people living with HIV (YLWH) is critical given the potential for aging-associated comorbidities resulting from HIV, especially in Cambodia where such data are limited. Therefore, we examined the prevalence and correlates of NCDs in YLWH and compared it to a nationally representative sample of young people not otherwise infected. We collected data from a sample of 370 YLWH aged 18–29 years attending three HIV clinics in Cambodia between 2019 and 2020. Our comparison group were 486 young people who participated in the Ministry of Health/WHO 2016 Noncommunicable Disease Risk Factor Surveillance (STEP survey). Both surveys used a standardized questionnaire to collect information on lifestyle factors and World Health Organization protocols for physical and biochemical measurements. We compared the prevalence of diabetes, hypertension, and high cholesterolemia between the two groups and examined the relationship between these conditions and HIV. We found 16 (4%), 22 (6%), and 72 (20%) had diabetes, hypertension, and high cholesterolemia, respectively, among YLWH, compared to 4 (1%), 22 (4%), and 49 (11%) among the general population. In logistic regression, YLWH were at higher odds of diabetes/prediabetes and high cholesterolemia compared with the young general population, aOR = 6.64 (95% CI 3.62–12.19) and aOR = 7.95 (95% CI 3.98–15.87), respectively. Our findings demonstrate that YLWH in Cambodia face multiple metabolic disorders and NCDs despite their young age and that accessible screening measures and treatment for these conditions are needed in order to combat NCDs in the future.

HIV virological non-suppression is highly prevalent among 18- to 24-year-old youths on antiretroviral therapy at the Kenyan coast

BackgroundIn sub-Saharan Africa, data on virologic outcomes of young people living with HIV (YLWH) enrolled on antiretroviral therapy (ART) remains scarce. In this study, we describe the prevalence of HIV virological non-suppression (VNS) and its associated factors among YLWH aged 18–24 years from the Kenyan coast.MethodsData were analyzed for 384 YLWH who participated in a larger cross-sectional study conducted between November 2018 and September 2019 in two counties at the Kenyan coast (Kilifi and Mombasa). Descriptive statistics were used to summarize sample characteristics and logistic regression was used for statistical modeling of factors associated with VNS. In this study, VNS was defined as plasma viral load ≥ 1000 copies/mL.ResultsAmong these YLWH with a mean age of 20.7 years (SD = 2.2); 55.5% females, the overall prevalence of VNS was 32.0% (95% Confidence interval (95% CI): 27.5, 36.9%). In the multivariable logistic regression analysis, being from a largely rural setting (adjusted Odds Ratio (aOR) 1.73, 95% CI 1.10, 2.71; p = 0.02), underweight (aOR 1.87, 95% CI 1.16, 3.01; p = 0.01) and low self-reported ART adherence (aOR 2.83, 95% CI 1.34, 6.00; p = 0.01) were significantly associated with higher odds of VNS in YLWH.ConclusionsIn this study, high levels of VNS were observed among YLWH and this was significantly associated with rural residency, nutritional and ART adherence problems. ART adherence counselling and nutritional support and education should be intensified in this setting targeting YLWH residing mostly in rural areas. Given the high frequency of VNS, there is need to closely monitor viral load and profile HIV drug resistance patterns in youths from the Kenyan coast with confirmed virologic failure. The latter will help understand whether drug resistance also contributes to poor viral suppression in addition to, or exclusive of suboptimal ART adherence.

AN ASSESSMENT OF MEDICATION ADHERENCE AND RISK PERCEPTION AMONG YOUNG PEOPLE LIVING IN NIGER STATE, NIGERIA

Background:Young People living with HIV (YPLHIV) enrolled in HIV treatment experience a higher rate of interruption in treatment, sub-optimal medication adherence, and greater HIV-related mortality compared with younger children or adults.This study assessed the relationship between risk perception and medication adherence among Young people aged 18 to 24 years living with HIV in Niger State, Nigeria Methods:A cross-sectional survey was conducted in February 2022 utilizing a pretested 43-item questionnaire (Cronbachs alpha of 0.7654) among 208 randomly selected Young People Living with HIV (YPLHIV) from four facilities in Niger State, Nigeria. The data was analyzed using STATA 15.0 with significance level set at p<0.05. Results:Results indicated that 161 (77.4 %) females and 47(22.6%) males with mean age 21.47 ± 1.92 years participated in the study.Perception of risk of complications from poor treatment measured on a 36-point scale recorded a mean score of 15.21 ± 13.77 and medication adherence measured on a 27-point scale similarly recorded a mean score of 14.72 ± 8.59 representing, representing 54.5% adherence rate for the participants in the study.There was no significant difference in measures of adherence to treatment and perception of risk of poor treatment recorded between males and females. Conclusion: The findings suggest that the medication adherence rate among YPLHIV in this study was sub-optimal and require stimulation through appropriate health promotion intervention to improve ART treatment outcomes.

FACTORS INFLUENCING MEDICATION ADHERENCE AMONG YOUNG PEOPLE LIVING WITH HIV IN NIGER STATE, NIGERIA

The global effort to address HIV/AIDS prevalence rest with a holistic intervention that promotes adherence and reduces the sociocultural factors limiting treatment adherence. This study assessed the predictors of antiretroviral therapy (ART) adherence among Young People Living with HIV (YPLHIV) in Niger State, Nigeria. The study was a cross-sectional survey utilizing a 43-item validated questionnaire to collect information on HIV medication adherence among 208 young people living with HIV currently enrolled in four facilities providing free comprehensive HIV care and treatment services in Niger State Nigeria. Univariate, bivariate and multivariate analyses were conducted at p=0.05 significance level. The age of participants ranged from 18 to 24 years with a mean age of 21.5 ± 1.92 years. Participants had been on antiretroviral (ARV) drugs for a period ranging between one to 14 years. The overall adherence rate in the study was 20% and was unevenly distributed across the four sites. In bivariate analysis, factors associated with ART medication adherence include educational attainment, religion and knowledge of medication adherence practices. Participants with higher education of at least a secondary school certificate were significantly more likely to adhere to ART (100%) than the lowly educated persons (0%), (p <0.0001). Similarly, other significant correlates of adherence at the bivariate level included knowledge of medication adherence (p <0.0001) and religion (p=0.038). Medication adherence is sub-optimal among Young People Living with HIV in Niger State and this study recommends holistic youth-friendly health literacy interventions programs to improve adherence to antiretroviral therapy among this population.

Stigma, discrimination and non-disclosure among young people living with HIV in Lagos, Nigeria.

Introductionyoung people living with HIV (YPLH) constitute a significant population towards ending the AIDS epidemic. About half of YPLH are undiagnosed and one-third of new infections occurring among them. Stigma and discrimination remaina predominant enigma in the social response to HIV.Methodsthis was a descriptive cross-sectional study among 124 YPLH aged 15-24 years selected by non-probability sampling from four antiretroviral centres targeted at young people across Lagos State. Ethical approval and informed consent were obtained. Data analysis was done using Epi info software version 7 and the level of significance was set at p<0.05.Resultsthe mean age of the participants was 19.4±3.2 years. Among the stigma variants, public stigma was the highest (48.4%), followed by anticipated stigma (20.2%), internalized stigma (14.5%), and enacted stigma (10.7%) while 7.3% of respondents experienced all forms. Thirty-seven percent of respondents had experienced one form of discrimination, with the most common form being ‘treated with hostility by strangers´ (14.5%). The disclosure level was 56.5%. The most predominant reasons for non-disclosure were fear of rejection by other people (57.3%). Diagnosis at an earlier age and living with a single parent were associated with lower disclosure levels (p‹0.001).Conclusionoverall stigma levels were found to be low, with differences in the individual stigma variants. The most common form of HIV-related discrimination reported in this study was being treated with hostility by strangers. Fear of rejection by other people was the main reason for non-disclosure among YPLH. The use of a multidisciplinary approach is needed to reduce the impact of stigma and discrimination among YPLH.

Preferences for a Game-Based SMS Adherence Intervention Among Young People Living with HIV in Ghana: A Qualitative Study.

Young people living with HIV (YPLH) are at risk for poor treatment adherence. Short message service (SMS) interventions can improve adherence, yet few exist for YPLH. Our study investigated preferences for a game-based SMS intervention among YPLH in Ghana. Thirty-two YPLH, ages 18 to 24, were recruited from an HIV clinic to complete in-depth interviews. Content analysis of interview data revealed areas of technology use relevant to intervention implementation, including mobile communication preferences, internet access, and mobile game use. Participants reported high perceived utility towards intervention features: treatment reminders, gamification components, and involvement of supportive individuals (e.g., providers). Issues with privacy, literacy, and cultural/developmental appropriateness were among concerns raised. Suggestions were made for strengthening basic SMS features (e.g., using code words to protect privacy) and incorporating advanced features (e.g., simplifying game interactions). This novel approach may help engage YPLH in HIV care if carefully developed with attention towards its mechanisms and user preferences.

Routine HIV clinic visit adherence in the African Cohort Study

BackgroundRetention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS).MethodsIn 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits.ResultsBetween January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19).ConclusionsInconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression.

Characterization of the Population Affected by the 6-Month Recertification Criterion of the Ryan White HIV/AIDS Program's AIDS Drug Assistance Program in Washington State, 2017-2019.

AIDS Drug Assistance Programs (ADAPs) provide financial support for medical care for people living with HIV (PLWH) in the United States. Federal policy requires that clients recertify for the program every 6 months, which has been described as a barrier to care access. Our objective was to describe the prevalence of and factors associated with ADAP disenrollment in Washington State. Between 2017 and 2019, we categorized ADAP clients by the success of their recertification applications as follows: (1) continuously enrolled, (2) ruled ineligible, or (3) disenrolled if they failed to recertify. We compared individuals who were disenrolled with those who were continuously enrolled by demographic and socioeconomic characteristics and engagement with case management using data from the Washington State HIV Surveillance and Ryan White data systems. From 2017 to 2019, 5480 clients were enrolled in ADAP, of whom 1423 (26%) were disenrolled and 984 (18%) were ruled ineligible at least once. Compared with those who were continuously enrolled, disenrolled PLWH were more likely to be Black [unadjusted prevalence ratio (PR) vs White 1.31, 95% confidence interval (CI): 1.17 to 1.46], uninsured (PR vs private insurance 1.24, 95% CI: 1.10 to 1.40), and younger (PR 25-34 vs 35-44 years 1.23, 95% CI: 1.08 to 1.41). The median time to return after disenrollment was 12 months (95% CI: 8 to 19 months). Disenrollment after failure to recertify was the most common reason why PLWH lost ADAP coverage in Washington State. ADAP recertification procedures disproportionately affect Black, young, and uninsured PLWH and may contribute to disparities in HIV outcomes.

Ten-Year Trends of Hepatitis A Seroprevalence in People Living with HIV in Korea.

Epidemiological information on hepatitis A among people living with HIV (PLHIV) in Korea is scarce. This retrospective study was performed at a tertiary care hospital and included 756 PLHIV with anti- hepatitis A virus (HAV) IgG tests. Between 2012 and 2021, the age at anti-HAV IgG seroconversion is gradually delayed, and the proportion of individuals susceptible to HAV infection increased among adult PLHIV in Korea. The independent risk factors for HAV seropositivity were female sex and HBs antigen (Ag) positivity. Therefore, HAV vaccination is highly recommended for young PLHIV, especially for women or HBsAg-positive individuals.

Self-esteem and antiretroviral therapy adherence among young people living with HIV: An exploratory serial mediation analysis

Capitalising further on the benefits of antiretroviral therapy (ART) for individual treatment requires an improved understanding of the psychological processes that may affect optimal ART adherence among people living with HIV. We examined internalised HIV/AIDS-related stigma and body appreciation as mediators of the association between self-esteem and ART adherence among young people living with HIV (YPLHIV). A sample of 76 YPLHIV (Mage = 19.36, s.d.age = 2.56; male 56.58%) residing in an HIV hyperendemic region of South Africa completed self-report measures of self-esteem, internalised HIV/AIDS-related stigma, body appreciation, and ART adherence. Path-analytic mediation modelling was performed to test for direct and indirect effects linking self-esteem with ART adherence. Results of serial mediation analyses indicated that self-esteem and ART adherence were indirectly associated through a two-step path of internalised HIV/AIDS-related stigma and then body appreciation, as well as a one-step path through internalised HIV/AIDS-related stigma. The results provide preliminary support for internalised HIV/AIDS-related stigma and body appreciation as mechanisms underlying the association between self-esteem and ART adherence. Implications of the findings for promoting ART adherence among YPLHIV are discussed.Significance: Self-esteem and ART adherence were indirectly related through internalised HIV/AIDS-related stigma followed by body appreciation. Outcomes of intervention initiatives designed to promote ART adherence among young people living with HIV may be further improved by integrating components that target internalised HIV/AIDS-related stigma and body appreciation.

Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

BackgroundIn sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people.MethodsBetween November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators.ResultsThe point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p < 0.01; current illicit drug use, 7% vs. 15%, p < 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p < 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (< 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use.ConclusionsAt the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives.

An analysis of Knowledge of Sexual and Reproductive Health among Adolescents and Young persons Living with HIV: The case of Chitungwiza, Harare, Zimbabwe

It has been decades into the HIV pandemic, the position of the disease has advanced significantly from death sentence to a chronically manageable disease that can be lived with for long time. This evolution was made possible with the advent of antiretroviral therapy which allowed HIV infected children to reach adulthood. However, sexual, and reproductive needs of these generations remain unattended in many countries. The study sought to highlight the sexual and reproductive health issues affecting young people living with HIV in Chitungwiza and Waterfalls communities, targeting HIV positive young people aged 15-24 years. A mixed methods approach was adopted in which, Qualitative and Quantitative research methods were employed. A survey was conducted with 113 young people to quantify sexual and reproductive health issues affecting young people living with HIV (YPLWH). To solicitate community perceptions and opinions on childbearing among the Adolescents and Young persons living with HIV, 8 focus group discussions and key informant interviews were conducted to qualify the data from the survey. The findings indicated that sexual and reproductive health (SRH) knowledge heavily impacts YPLWH’. Socio-cultural barriers are major inhibiting factors limiting YPLWH. The study recommends that academic research, NGOs, and other stakeholders with support from the Ministry of Health, should conduct more studies on emerging HIV and SRH issues which will help in addressing knowledge gaps and provide evidence-based knowledge in public health. Overall, this will improve the reproductive health outcomes of young people living with HIV.

Group counselling for adherence support among young people failing first-line antiretroviral therapy in Zimbabwe.

BackgroundSub-optimal adherence to antiretroviral therapy (ART) is reportedly worse amongst young people living with HIV (YPLHIV). Group adherence counselling can be useful to improve adherence.ObjectivesWe evaluated an enhanced adherence counselling group intervention (EACGI) amongst YPLHIV failing a non-nucleoside reverse transcriptase (NNRTI)-based first-line ART regimen.MethodThis was a retrospective cohort study using routinely collected data of YPLHIV failing NNRTI-based first-line ART. Patients with confirmed virological failure were referred for EACGI, a 12-week curriculum of weekly, 1.5-h sessions accommodating 8–15 people per group. It aimed to facilitate readiness to switch to second-line ART and improve adherence through a mental health intervention. Viral loads of HIV were measured pre-EACGI; at baseline; 3, 6 and 12 months post switch.ResultsFifty-seven patients aged 13–25 years were invited to EACGI and followed for up to 48 weeks. Thirty-three (58%) patients attended at least four sessions, whilst 24 (42%) attended none. Amongst those who attended none, two (8%) were transferred out, three (13%) were lost to follow-up and two (8%) had died by week 48 of follow-up, whilst all who attended were still in care. By week 48, amongst patients still in care, 29%, 44% and 67% of those who attended no sessions, 4–9 and 10–12 sessions, respectively, had viral loads of < 50 copies/mL.ConclusionAn EACGI is a promising intervention for YPLHIV failing ART prior to treatment switch, leading to improved adherence. This study’s findings support the need for further enquiry into rigorous, evidence-based multilevel adherence interventions that are acceptable and effective for YPLHIV.

Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review.

IntroductionCommon mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub‐Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA.MethodsWe searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: “Depression OR Anxiety”, “Young people”, “HIV infections” and “sub‐Saharan Africa”.Results and discussionOut of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV‐negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV‐related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV‐positive status, bullying, sexual abuse, HIV‐related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms.ConclusionsThe burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV‐negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV‐clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth‐friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.