'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa

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dc.contributor.authorCluver, Lucie D
dc.contributor.authorHodes, Rebecca J
dc.contributor.authorToska, Elona
dc.contributor.authorKidiad, Khameer K
dc.contributor.authorOrkina, Mark F
dc.contributor.authorSherrf, Lorraine
dc.contributor.authorMeincka, Franziska
dc.date.accessioned2016-05-12T07:48:18Z
dc.date.available2016-05-12T07:48:18Z
dc.date.issued2015
dc.date.updated2016-05-12T07:31:58Z
dc.description.abstractObjectives: WHO guidelines recommend disclosure to HIV-positive children by school age in order to improve antiretroviral therapy (ART) adherence. However, quantitative evidence remains limited for adolescents. This study examines associations between adolescent knowledge of HIV-positive status and ART-adherence in South Africa. Design: A cross-sectional study of the largest known community-traced sample of HIVpositive adolescents. Six hundred and eighty-four ART-initiated adolescents aged 10–19 years (52% female, 79% perinatally infected) were interviewed. Methods: In a low-resource health district, all adolescents who had ever initiated ART in a stratified sample of 39 health facilities were identified and traced to 150 communities [n ¼ 1102, 351 excluded, 27 deceased, 40 (5.5%) refusals]. Quantitative interviews used standardized questionnaires and clinic records. Quantitative analyses used multivariate logistic regressions, and qualitative analyses used grounded theory for 18 months of interviews, focus groups and participant observations with 64 adolescents, caregivers and healthcare workers. Results: About 36% of adolescents reported past-week ART nonadherence, and 70% of adolescents knew their status. Adherence was associated with fewer opportunistic infection symptoms [odds ratio (OR) 0.55; 95% CI 0.40–0.76]. Adolescent knowledge of HIV-positive status was associated with higher adherence, independently of all cofactors (OR 2.18; 95% CI 1.47–3.24). Among perinatally infected adolescents who knew their status (n ¼ 362/540), disclosure prior to age 12 was associated with higher adherence (OR 2.65; 95% CI 1.34–5.22). Qualitative findings suggested that disclosure was undertaken sensitively in clinical and family settings, but that adults lacked awareness about adolescent understandings of HIV status. Conclusion: Early and full disclosure is strongly associated with improved adherence amongst ART-initiated adolescents. Disclosure may be an essential tool in improving adolescent adherence and reducing mortality and onwards transmission.en_ZA
dc.identifierhttp://dx.doi.org/10.1097/QAD.0000000000000695
dc.identifier.apacitationCluver, L. D., Hodes, R. J., Toska, E., Kidiad, K. K., Orkina, M. F., Sherrf, L., & Meincka, F. (2015). 'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. <i>AIDS</i>, http://hdl.handle.net/11427/19615en_ZA
dc.identifier.chicagocitationCluver, Lucie D, Rebecca J Hodes, Elona Toska, Khameer K Kidiad, Mark F Orkina, Lorraine Sherrf, and Franziska Meincka "'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa." <i>AIDS</i> (2015) http://hdl.handle.net/11427/19615en_ZA
dc.identifier.citationCluver, L. D., Hodes, R. J., Toska, E., Kidia, K. K., Orkin, F. M., Sherr, L., & Meinck, F. (2015). ‘HIV is like a tsotsi. ARVs are your guns’: associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. Aids, 29, S57-S65.en_ZA
dc.identifier.issn0269-9370en_ZA
dc.identifier.ris TY - Journal Article AU - Cluver, Lucie D AU - Hodes, Rebecca J AU - Toska, Elona AU - Kidiad, Khameer K AU - Orkina, Mark F AU - Sherrf, Lorraine AU - Meincka, Franziska AB - Objectives: WHO guidelines recommend disclosure to HIV-positive children by school age in order to improve antiretroviral therapy (ART) adherence. However, quantitative evidence remains limited for adolescents. This study examines associations between adolescent knowledge of HIV-positive status and ART-adherence in South Africa. Design: A cross-sectional study of the largest known community-traced sample of HIVpositive adolescents. Six hundred and eighty-four ART-initiated adolescents aged 10–19 years (52% female, 79% perinatally infected) were interviewed. Methods: In a low-resource health district, all adolescents who had ever initiated ART in a stratified sample of 39 health facilities were identified and traced to 150 communities [n ¼ 1102, 351 excluded, 27 deceased, 40 (5.5%) refusals]. Quantitative interviews used standardized questionnaires and clinic records. Quantitative analyses used multivariate logistic regressions, and qualitative analyses used grounded theory for 18 months of interviews, focus groups and participant observations with 64 adolescents, caregivers and healthcare workers. Results: About 36% of adolescents reported past-week ART nonadherence, and 70% of adolescents knew their status. Adherence was associated with fewer opportunistic infection symptoms [odds ratio (OR) 0.55; 95% CI 0.40–0.76]. Adolescent knowledge of HIV-positive status was associated with higher adherence, independently of all cofactors (OR 2.18; 95% CI 1.47–3.24). Among perinatally infected adolescents who knew their status (n ¼ 362/540), disclosure prior to age 12 was associated with higher adherence (OR 2.65; 95% CI 1.34–5.22). Qualitative findings suggested that disclosure was undertaken sensitively in clinical and family settings, but that adults lacked awareness about adolescent understandings of HIV status. Conclusion: Early and full disclosure is strongly associated with improved adherence amongst ART-initiated adolescents. Disclosure may be an essential tool in improving adolescent adherence and reducing mortality and onwards transmission. DA - 2015 DB - OpenUCT DP - University of Cape Town J1 - AIDS LK - https://open.uct.ac.za PB - University of Cape Town PY - 2015 SM - 0269-9370 T1 - 'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa TI - 'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa UR - http://hdl.handle.net/11427/19615 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/19615
dc.identifier.vancouvercitationCluver LD, Hodes RJ, Toska E, Kidiad KK, Orkina MF, Sherrf L, et al. 'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. AIDS. 2015; http://hdl.handle.net/11427/19615.en_ZA
dc.languageengen_ZA
dc.publisherInternational AIDS Societyen_ZA
dc.publisher.departmentCentre for Social Science Research(CSSR)en_ZA
dc.publisher.facultyFaculty of Humanitiesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.sourceAIDSen_ZA
dc.source.urihttp://www.lww.com/product/?0269-9370
dc.subject.otheradolescent adherence
dc.subject.otherantiretroviral therapy
dc.subject.otherdisclosure
dc.subject.otherHIV/AIDS
dc.title'HIV is like a tsotsi. ARVs are your guns': associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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