Browsing by Subject "adolescents"

Now showing 1 - 12 of 12
  • Thumbnail Image
    Item
    Open Access
    Adolescents’ Perspectives on the Drivers of Obesity Using a Group Model Building Approach: A South African Perspective
    (2022-02-14) Hendricks, Gaironeesa; Savona, Natalie; Aguiar, Anaely; Alaba, Olufunke; Booley, Sharmilah; Malczyk, Sonia; Nwosu, Emmanuel; Knai, Cecile; Rutter, Harry; Klepp, Knut-Inge; Harbron, Janetta
    Overweight and obesity increase the risk of a range of poor physiological and psychosocial health outcomes. Previous work with well-defined cohorts has explored the determinants of obesity and employed various methods and measures; however, less is known on the broader societal drivers, beyond individual-level influences, using a systems framework with adolescents. The aim of this study was to explore the drivers of obesity from adolescents’ perspectives using a systems approach through group model building in four South African schools. Group model building was used to generate 4 causal loop diagrams with 62 adolescents aged 16–18 years. These maps were merged into one final map, and the main themes were identified: (i) physical activity and social media use; (ii) physical activity, health-related morbidity, and socio-economic status; (iii) accessibility of unhealthy food and energy intake/body weight; (iv) psychological distress, body weight, and weight-related bullying; and (v) parental involvement and unhealthy food intake. Our study identified meaningful policy-relevant insights into the drivers of adolescent obesity, as described by the young people themselves in a South African context. This approach, both the process of construction and the final visualization, provides a basis for taking a novel approach to prevention and intervention recommendations for adolescent obesity.
  • Thumbnail Image
    Item
    Open Access
    An investigation into the progression of premarital fertility since the onset of Zimbabwe's fertility transition
    (2021) Ngwenya, Chantelle Linda; Moultrie, Thomas
    Premarital fertility, that is, childbearing before first marriage, is an important yet under researched demographic topic in sub-Saharan Africa. In Zimbabwe, the distinction by marital status in fertility research is hardly drawn. Hence, a gap exists in the knowledge of premarital fertility levels. This research aims to investigate levels of, and factors associated with, premarital fertility since the onset of Zimbabwe's fertility transition in the mid-1980s. The research employed direct fertility estimation techniques to effectively compare premarital, marital, and overall fertility trends between 1988 and 2015. Cox proportional-hazards regression and forest plot analyses were then used to explain changes in factors associated with the timing of premarital first births over the same period. Data quality assessments were carried out using the method of cohortperiod fertility rates to provide explanations for any erratic results. The results showed that premarital fertility was constant and moderate, with an average of 0.7 children per woman, between 1988 and 2015. While most premarital first births consistently occurred to younger women, from 2005 onwards, they increased among women aged above 24 years and decreased among adolescents. An increase in age, commencing sexual activity after adolescence, and improved socio-economic status including level of education decreased the relative risk of having a premarital first birth. However, delaying marriage past young womanhood, history of contraceptive use, Ndebele ethnicity, and residence in regions other than Manicaland and Masvingo, especially Ndebele dominated regions, increased the same risk by 465.0%, 45.5%, 136.0% and up to 135.0% respectively. The stagnation of premarital fertility between 1988 and 2015 while both marital and overall fertility first declined and then stalled indicates that there is insufficient evidence to suggest that premarital fertility had contributed to the stall of fertility decline in Zimbabwe from the mid-1990s. The timing of premarital first births since the start of the fertility transition in the 1980s has had a strong ethnic and cultural bias. Due to evidence of the effect of migrancy and tourism on premarital fertility in border and tourism towns, an extension into the theory of migrant premarital sexual behaviour to detail the risk of premarital fertility among border town residents who interact with but are neither migrants nor tourists is recommended.
  • Thumbnail Image
    Item
    Open Access
    Development and validation of the School Clinical Rugby Measure (SCRuM) test battery: understanding the qualities or skills defining good male adolescent rugby union players
    (2020) Chiwaridzo, Matthew; Ferguson, Gillian D; Smits-Engelsman, Bouwien CM
    Background: Globally, the number of schoolboy adolescents playing highly competitive rugby is increasing even in countries such as Zimbabwe hardly known for dominating international rugby events. Given the increased participation rates, burgeoning talent identification and recruitment programs and the reportedly high injury risk associated with competitive youth rugby in Zimbabwe and globally, the minimal qualities or skills defining good male adolescent rugby players need further clarification. This study assembled a testing battery and compared the anthropometric variables, physiological characteristics and rugby-specific game skills of Zimbabwean schoolboys to identify qualities and/or skills discriminating elite from sub-elite male adolescent rugby players and non-rugby players within and between Under 16 (U16) and U19 age categories. Methods: This study was structured in three phases. Phase I developed the School Clinical Rugby Measure (SCRuM) test battery based on amalgamated information derived from narrative literature review, qualitative study and two systematic reviews. Using mixed methods sequential explanatory study designs, Phase II refined the test battery through the evaluation of face and logical validity using key informants (n=5) and rugby experts (n=20), respectively. Subsequently, rugby coaches (n=30) assessed the practical feasibility of implementing each SCRuM test item in the local context considering test equipment, procedural and acceptability issues. Phase III evaluated the test-retest reliability of each SCRuM test item among a sample of elite U16s (n=41) and U19s (n=41). The final study in Phase III compared cross-sectional test performances of 208 athletes from different playing standards and age category to identify SCRuM test items discriminating (i) older (U19) players from younger (U16) players regardless of playing standards, and (ii) elite from both sub-elite and nonrugby players regardless of age. Results: Phase I produced the first version of the SCRuM test battery with 23 variables. Phase II reduced the constituent components to 15 variables. The test-retest reliability study showed high intraclass correlation coefficient (ICC>0.70) for all SCRuM test items except for the 5-m, 10-m speed tests and passing-for-accuracy test. Age category had a significant main effect on all SCRuM test items except for sum of seven skinfolds (p=0.45, η2 p=0.003). Playing standard had a significant main effect ii on all variables except for height (p=0.40, η2 p=0.01) and sum of seven skinfolds (p=0.11, η2 p =0.02). Upper-and-lower body muscular strength and power, prolonged high-intensity intermittent running ability, repeated high-intensity exercise performance ability, tackling, passing and catching significantly improved with increasing playing standards. However, the Yo-Yo intermittent recovery level 1 test, vertical jump test, tackling proficiency test and running-and-catching ability skills test demonstrated greater discriminative ability across playing standards among U16s. The 40-m speed test, 2-kg medicine ball chest throw test, repeated high-intensity exercise test, one-repetition maximum bench press and back squat tests, and passing ability skills test showed better discriminative validity for differentiating U19s by playing standards. Conclusion: Irrespective of playing standard and consistent with previous studies, all SCRuM test items significantly increased with age except for skinfolds measures. These results highlight the sensitivity of component SCRuM test items in discriminating younger (U16s) from older (U19s) athletes. U16 coaches should consider these differences when designing training interventions to assist with the development of prospective U19 players. However, prolonged high-intensity intermittent running ability, lower-body muscular power, tackling proficiency and running-andcatching ability demonstrated greater discriminative ability among U16s only, indicating a possible link to higher playing standards for that age category. Upper-body muscular power, upper-and-lowerbody muscular strength, 40-m sprinting ability, repeated high-intensity exercise performance ability, and passing ability significantly improved with playing standards among U19s, highlighting the physiological characteristics and game skills capable of differentiating elite male adolescent rugby players from both sub-elite or non-rugby players at that age category. Collectively, these findings provide insight to the high school rugby coaches into the qualities and skills contextually relevant for training for the attainment of higher playing standards in schoolboy rugby at distinct age categories.
  • Thumbnail Image
    Item
    Restricted
    Empathy in autism spectrum disorder: Predictions from child/adolescent temperament, parenting styles, and parenting stress
    (2019) Ross, Toni Carmen Faith; Malcolm-Smith, Susan; Hamilton, Katie
    Individuals with autism spectrum disorder (ASD) exhibit definitional impairments in social relatedness; a phenomenon that can be explained, in part, by their deficits in empathy. Despite the extent of these deficits, relatively little is known about which factors promote or impede empathic functioning within this group. To date, studies of neurotypical children and adolescents suggest the explanatory power of temperament, parenting style, and parenting stress; associations which have yet to be adequately explored with ASD. Thus, the overarching aim of this investigation was to test whether the aforementioned intra- and interindividual features would predict empathy amongst children and adolescents with ASD. To account for some of the heterogeneity in ASD, two groups of parent-child dyads were recruited: one comprising male children and adolescents with intact receptive and expressive language (n = 40, M = 7.68 years); the other, males with little to no language use in either domain (n = 40, M = 9.09 years). A third group of parent-child pairs comprising male neurotypical children and adolescents with age-appropriate language functioning was included as a comparison sample (n = 40, M = 9.53 years). Parents completed wellestablished questionnaires pertaining to child/adolescent temperament and empathy, as well as parenting style and parenting stress, primarily via telephonic interviews. Results showed that temperamental regulation and negative affectivity were linked to empathy within the neurotypical group in positive and inverse directions, respectively. Only regulatory processes were positively associated with empathy within the non-verbal ASD group, whilst only negative affectivity was inversely associated to empathy within the verbal ASD group. Further, warm, responsive, autonomy-promoting parenting was positively associated with empathy within the neurotypical group, whilst punitive and lax parenting were inversely associated with empathy. Positive forms of parenting were also found to predict empathy within both ASD groups – though somewhat less so within the verbal ASD group. Perhaps a consequence of the severity of their empathic deficits, lax and permissive parenting techniques were not tied to empathy within the ASD groups. Finally, parenting stress was inversely linked to empathy within the non-verbal ASD and neurotypical groups only. Results highlight that findings obtained within neurotypical samples cannot always be extrapolated to ASD. Results further underscore the need for ASD interventions to adopt a family systems perspective, teaching parents how to perceive and respond to their children in adaptive ways.
  • Thumbnail Image
    Item
    Open Access
    Expectations and Preferences of Parents and Adolescents Regarding Feedback of Individual Genetic Findings in an HIV-TB Genomic Research Project in Botswana
    (2022) Ralefala, Dimpho; De Vries, Jantina; Kasule, Mary; Matshaba, Mogomotsi
    Background: There has been tremendous progress in the use of genomics1 in biomedical research and medical care since the launch of the Human Genome Project in 1990. However, it has also introduced new ethical challenges regarding the feedback of findings generated in genomic sequencing. While some would argue in support of the return of individual findings generated from genomics research, participants' preferences regarding which findings should be fed back differs. Most literature discusses feedback of findings in high income countries and very few address this issue in lower and middle-income countries (LMICs). As a result, it remains unclear whether and how individual findings from genomic studies in Africa should be fed back, who should provide these results and when. Methods: In order to contribute to addressing this gap, an empirical study was conducted to explore expectations and preferences for feedback of individual genetic findings in an HIV-TB genomics research project in Botswana. A qualitative study methodology involving deliberative focus group discussions (dFGDs) and in-depth interviews (IDIs) was used. Participants for this study were adolescents involved in an HIV-TB genomics study being conducted at the Botswana-Baylor Children's Clinical Centre of Excellence (BBCCCE). Parents and caregivers of children enrolled in that same genomic study were also enrolled in this study. A total of 93 participants (44 adolescents and 49 parents and caregivers) were enrolled in 12 dFGDs (6 groups of adolescents and 6 groups of parents and caregivers). Each group of participants met twice within a week, resulting in a total of 24 dFGD meetings. Participants of the dFGDs and in-depth interviews were selected purposively. Additionally, indepth interviews were conducted with 12 dFGD participants (6 adolescents and 6 parents or caregivers). The dFGDs and IDIs were conducted in Setswana, audio-recorded, transcribed and translated into English. Data were imported into NVivo 12 and analysed using the framework approach for qualitative data analysis. Results: The study findings revealed that participants' desire to receive individual genetic results is underpinned by their cultural values, mainly solidarity and reciprocity. Participants viewed research participation as a mutual relationship and considered the return of research results to be one way of reciprocating their efforts. This seems to be underpinned by the principle of Ubuntu which advocates for solidarity and reciprocity within communities. Participants noted that when reciprocity obligations are respected, participants feel valued and expressed that not respecting reciprocity expectations could undermine participants' trust and participation in future studies. Almost all participants wanted to receive individual genetic results. While parents and caregivers wanted to receive individual genetic results regardless of their severity, preventability or actionability, adolescents were reluctant to receive results for genetic conditions that are severe and non-preventable, especially if they are also unactionable. Participants advanced different reasons for feedback of results including for awareness, improving lifestyle, accepting one's' situation, and preparing for the future. The findings also reveal the importance of taking into account participants' context, relations and empowerment when making decisions about whether and which results ought to be fed back. When asked about practical considerations for feedback of results, both adolescents and parents expressed that they would prefer to receive individual genetic results in person, with adolescents preferring researchers to provide feedback, while parents preferred feedback from doctors associated with the study. Adolescents and parents both expressed that feedback should be supported by counselling, but they differed on the timing of feedback. Most participants shared that they would like to be informed about the possibility of discovering individual genetic results during the consent process and that consent be obtained for feedback during the enrolment process. They further expressed that in cases where prior consent to feedback was not obtained, then participants should be re-contacted where lifesaving genetic information is discovered. Participants emphasized the need for researchers to ensure that participants' decisions regarding feedback of results are well-informed. Autonomy, transparency, and communication were identified as key values to uphold during the consent process. Conclusion: In conclusion, expectations of solidarity and reciprocity could translate into an obligation to feedback selected individual genetic results in African genomics research. Decisions on practicalities for feedback of results should take into account participants' context and considerations of participants' preferences. For example, in settings like BBCCCE it might be feasible for the study team to relay participants' results to treating doctors in the same centre, while also organising counselling services if necessary. However, in cases where a study is done in a public facility with limited resources, that could be difficult to implement. Consequently, researchers may have to take up the responsibility of feeding back individual results as well as providing genetic counselling in such settings. To make these decisions, researchers should engage with relevant stakeholders including policymakers and local Institutional Review Boards (IRBs) so as to make informed decisions regarding the feasibility and acceptability of their approach to feedback of results. Obtaining participants' consent for feedback of results is important to ensure that their rights and wellbeing are protected in research. This is critical in building trust relationships between participants and researchers. Lastly, although this study is focused in Botswana, these findings could also be generalised to similar contexts in Africa and provide an authoritative voice to H3Africa to be able to mandate projects with potential to generate individual genetic results to make provisions to feedback these results to study participants.
  • Thumbnail Image
    Item
    Open Access
    Factors influencing cyberbullying among young adults: Instagram case study 
    (2022) Oladimeji, Anthonia; Kyobe, Michael
    Cyberbullying is one of the major problems of social networking sites, which has been known to have prolonged adverse psychological effects on social network users. Cyberbullying has been discussed a lot in the literature, but little research has been done on cyberbullying and its related factors. This study seeks to examine the factors influencing cyberbullying on Instagram among young adults. Instagram was chosen as a case study for the thesis because research shows that Instagram is the most preferred social networking site among the age cohort (18–30), who are popularly referred to as young adults. An extensive review of the literature was carried out, and six constructs (Instagram Usage, Vulnerability, Peer Pressure, Anonymity, and Instagram Features) were used to examine the influence of cyberbullying among young adults on Instagram. This study draws from the theory of routine activity theory (RAT), which is grounded on the postulation that criminal acts can be easily committed by any individual who has the opportunity. The researcher reviewed the process and deployed a methodological and concept-centric approach to create a comprehensive conceptual model that included key factors. This dissertation is different from most cyberbullying research in the sense that it reviews cyberbullying behaviours from the context in which they occur rather than the intent or motivation of the perpetrator. The model allowed a holistic examination of factors that influenced cyberbullying behaviours on Instagram. Using a survey methodology, over 201 Instagram users who are also students at the University of Cape Town completed an instrument measuring factor influencing cyberbullying. The researcher deployed Smart PLS, a statistical package for the social sciences, to test for reliability, validity and to analyse the entire dataset. The study critically examined the factors that influence cyberbullying among young adults. The results of this dissertation indicated that peer pressure and online vulnerability have a strong significance in cyberbullying behaviours. Surprisingly, Instagram usage had a weak correlation with cyberbullying behaviours. This study contributes significantly to the exciting research on cyberbullying as it helps identify the factors that contribute to cyberbullying behaviours. From this research, cyberbullying interventions or solutions can be accurately developed.
  • Thumbnail Image
    Item
    Open Access
    HIV vaccine trial safety and retention among 18-20 year olds in the HVTN 503/Phambili study support the inclusion of adolescents in future trials
    (BioMed Central Ltd, 2012) Volk, JE; Hessol, NA; Gray, GE; Kublin, JG; Churchyard, G; Mlisana, K; Nchabeleng, M; Buchbinder, SP; Bekker, L
    Worldwide, many adolescents, especially women, acquire HIV before age 18. Yet to date, no HIV vaccine trials have enrolled adolescents. Reasons for excluding adolescents from these trials include regulations protecting vulnerable subjects and concerns regarding informed consent, social harms, adverse events, and loss to follow-up.
  • No Thumbnail Available
    Item
    Open Access
    Investigating the effects of living with HIV on neural circuits involved in reward processing in adolescents
    (2024) Mac Arthur, Anika; Meintjes, Ernesta; Robertson, Frances
    The CHER (Children with HIV Early Antiretroviral) trial found that early ART (12- weeks) reduced mortality and morbidity in children with perinatal HIV (CPHIV). Despite early ART, CPHIV from the CHER trial demonstrate neuroimaging alterations, but little is known about the effects of PHIV and long-term ART on the adolescent brain. Adolescence is a time of increased vulnerability to risk-taking behaviour. Here, neural circuits involved in reward processing during adolescence are investigated using functional MRI (fMRI). FMRI scans acquired during a Reward Magnitude Task were available for 106 socio economically matched adolescents (66 children perinatally infected with HIV (CPHIV), 40 controls living without HIV; age 150.4 years). Data were preprocessed using fMRIPrep. Differences in brain activation for anticipation, monetary wins vs losses, and reward/loss outcome magnitudes were compared between CPHIV and controls using FSL FEAT. Z-statistic images were thresholded at Z>3.1 and a cluster significance threshold of p=0.05. Across all subjects, there were robust responses to reward processing (win>loss) in the striatum (38,610mm3 ; peak MNI -10.1; 9.1; 0.7) and in the (ventromedial) prefrontal cortex (11,280mm3 ; peak MNI -5.3; 25.9; 41.5). There were no regions where activation increases, for any of our contrasts, were greater in CPHIV than controls, but CPHIV showed smaller activation increases than controls during anticipation and reward processing. We specifically saw smaller activation increases during processing of larger wins in 2 distinct small left superior frontal clusters as well as in the left paracingulate gyrus. Similar to findings from the Human Connectome Project in Development, the task reliably activated striatal and medial frontal regions involved in decision-making and reward seeking/processing. While we found no differences between CPHIV and controls within this reward processing network, CPHIV showed smaller activation differences in our contrasts in the left superior frontal cortex – a region involved in the working memory component of executive function. Notably, impaired working memory processing and storage, especially in the visual domain, has been reported previously in children living with HIV. The current finding suggests that HIV-related brain response abnormalities in working memory regions may impact reward processing.
  • No Thumbnail Available
    Item
    Open Access
    Prevalence of depression and anxiety and associated risk factors among adolescent offenders within the juvenile justice system in Bulawayo and Matabeleland North Province(s), Zimbabwe
    (2024) Marufu, Marshall Takudzwa; Sorsdahl, Katherine; Williams, Petal Petersen; Besada, Donela; Mangez, Walter
    Background The mental health of adolescents is becoming an increasing public health concern. Mental health conditions such as depression and have their onset during childhood. Research has shown that adolescents entering the juvenile justice system are particularly vulnerable to depression and anxiety. Despite the negative consequences associated with these conditions among adolescent offenders, there is a dearth of studies conducted in low and middle countries including Zimbabwe on the prevalence and factors associated with symptoms of depression and anxiety among adolescent offenders between 10-17 years within the juvenile justice system. Thus, the aim of this study is to determine the prevalence and factors associated with symptoms of depression and anxiety among adolescent offenders between 10-17 years within the juvenile justice system in Bulawayo and Matabeleland North Province, Zimbabwe. Methods In total, 130 adolescent offenders aged between 10 and 17 years were recruited in the cross- sectional study using a convenient sampling technique. The Centre for Epidemiological Studies Depression Scale (CES-D-10) and Generalized Anxiety Disorder (GAD-7) were used to measure symptoms of depression and anxiety, respectively. The Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Fagerstrom Test for Nicotine Dependence (FTND), Rosenberg Self-Esteem Scale, and Sexual Risk Behaviour Beliefs and Self-Efficacy Scales were used to measure individual factors associated depression and anxiety. The Juvenile Victimization Questionnaire (JVQ) was used to measure factors associated with mental health conditions at the family level, while the Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure associations at the social level. Means and proportions were used to describe socio- demographic data as well as the prevalence of potential mental health conditions (depression and anxiety). Unadjusted and adjusted associations between individual, family, and social risk factors and the presence of depression and anxiety were also explored. Only those variables that were significant in the unadjusted models were included in the final adjusted regression model. The standard cutoff level for statistical significance used in this analysis is a p-value of 0.05 or less. The findings are presented in the form of odds ratios (ORs) with 95% confidence intervals (CIs). Page | 5 Results The prevalence of depression and anxiety among participants was 18.5% and 10.8% respectively. In total, 7.6% of participants had reported symptoms of both depression and anxiety, highlighting the co-morbidity of mental health conditions among adolescent offenders. After adjusting models, results indicate that adolescents with a known history of mental health problems were more likely to report symptoms of anxiety than those without a known history (OR=15.10, 95% CI 1.86 -122.78). The adjusted models also indicate that adolescents who report more social support are less likely to experience symptoms of anxiety (OR=0.96, 95% CI 0.92 - 0.99). Additionally, the adjusted model shows that participants with high risky sexual behaviour (OR=1.19, 95% CI 1.05-1.35), high self-esteem (OR=1.19, 95% CI 1.05-1.35) and experiencing juvenile victimization or childhood violence (OR=46.87, 95% CI 3.89-565.237) were more likely to have symptoms of depression. Finally, results show that being a first time offender (OR=0.17, 95% CI 0.04-0.80) and having a mother who is alive (OR=0.12, 95% CI 0.02-0.76) are protective factors that reduces the risk of young offenders experiencing symptoms of depression. Conclusion Results from the study show that symptoms of depression and anxiety are prevalent among adolescent offenders within the juvenile justice system and are associated with several risk factors. Selective prevention interventions are recommended for this vulnerable population.
  • Thumbnail Image
    Item
    Restricted
    Relationships between adolescents and adults: The significance of narrative and context.
    (Taylor & Francis, 2006) Shelmerdine, Sarah
    A substantial body of research links the developmental outcomes of young people to the relationships they have with adults. However, very little research provides insight into the mechanisms whereby relationships achieve their outcomes or the specific qualities of those relationships. This paper explores the construction of relationships between young people and adults in three different socio-cultural settings in Cape Town. Four young people in each setting, namely Ocean View, Fish Hoek and Masiphumelele were interviewed about their relationships with the most important adults in their lives. Where possible, the adults they identified were interviewed also. Interviews were unstructured and analysed thematically. Fundamentally, constructions of the relationships in all three settings were found to be similar. All adults encouraged young people to succeed and sought to protect them against risk. However, the nature of the opportunities and risks, and of the material context in general, differ between the three different study sites and have considerable import for the narratives of the relationships from each. The paper?argues that the differences between the three sites indicate the responsiveness and adaptation of ideals and discourses to environmental demands, rather than fundamental ideological discrepancies.
  • Thumbnail Image
    Item
    Open Access
    Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa
    (BioMed Central Ltd, 2012) Nglazi, Mweete; Kranzer, Katharina; Holele, Pearl; Kaplan, Richard; Mark, Daniella; Jaspan, Heather; Lawn, Stephen; Wood, Robin; Bekker, Linda-Gail
    BACKGROUND: Very few data are available on treatment outcomes of adolescents living with HIV infection (whether perinatally acquired or sexually acquired) in sub-Saharan Africa. The present study therefore compared the treatment outcomes in adolescents with those of young adults at a public sector community-based ART programme in Cape Town, South Africa. METHODS: Treatment outcomes of adolescents (9-19 years) were compared with those of young adults (20-28 years), enrolled in a prospective cohort between September 2002 and June 2009. Kaplan-Meier estimates and Cox proportional hazard models were used to assess outcomes and determine associations with age, while adjusting for potential confounders. The treatment outcomes were mortality, loss to follow-up (LTFU), immunological response, virological suppression and virological failure. RESULTS: 883 patients, including 65 adolescents (47 perinatally infected and 17 sexually infected) and 818 young adults, received ART. There was no difference in median baseline CD4 cell count between adolescents and young adults (133.5 vs 116 cells/muL; p = 0.31). Overall mortality rates in adolescents and young adults were 1.2 (0.3-4.8) and 3.1 (2.4-3.9) deaths per 100 person-years, respectively. Adolescents had lower rates of virological suppression (< 400 copies/mL) at 48 weeks (27.3% vs 63.1%; p < 0.001). Despite this, however, the median change in CD4 count from baseline at 48 weeks of ART was significantly greater for adolescents than young adults (373 vs 187 cells/muL; p = 0.0001). Treatment failure rates were 8.2 (4.6-14.4) and 5.0 (4.1-6.1) per 100 person-years in the two groups. In multivariate analyses, there was no significant difference in LTFU and mortality between age groups but increased risk in virological failure [AHR 2.06 (95% CI 1.11-3.81; p = 0.002)] in adolescents. CONCLUSIONS: Despite lower virological suppression rates and higher rates of virological failure, immunological responses were nevertheless greater in adolescents than young adults whereas rates of mortality and LTFU were similar. Further studies to determine the reasons for poorer virological outcomes are needed.
  • Thumbnail Image
    Item
    Open Access
    Where do HIV-infected adolescents go after transfer? – Tracking transition/transfer of HIV-infected adolescents using linkage of cohort data to a health information system platform
    (2017) Davies, Mary-Ann; Tsondai, Priscilla; Tiffin, Nicki; Eley, Brian; Rabie, Helena; Euvrard, Jonathan; Orrell, Catherine; Prozesky, Hans; Wood, Robin; Cogill, Dolphina; Haas, Andreas D; Sohn, Annette H; Boulle, Andrew
    Introduction: To evaluate long-term outcomes in HIV-infected adolescents, it is important to identify ways of tracking outcomes after transfer to a different health facility. The Department of Health (DoH) in the Western Cape Province (WCP) of South Africa uses a single unique identifier for all patients across the health service platform. We examined adolescent outcomes after transfer by linking data from four International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) cohorts in the WCP with DoH data.