Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?
Identifieur interne : 000125 ( Main/Exploration ); précédent : 000124; suivant : 000126Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?
Auteurs : L D Cluver [Royaume-Uni, Afrique du Sud] ; E. Toska [Royaume-Uni, Afrique du Sud] ; F M Orkin [Afrique du Sud] ; F. Meinck [Royaume-Uni] ; R. Hodes [Royaume-Uni, Afrique du Sud] ; A R Yakubovich [Royaume-Uni] ; L. Sherr [Royaume-Uni]Source :
- AIDS care [ 1360-0451 ] ; 2016.
Descripteurs français
- KwdFr :
- Adhésion au traitement médicamenteux (MeSH), Adolescent (MeSH), Afrique de l'Est (MeSH), Charge virale (MeSH), Comportement de réduction des risques (MeSH), Enfant (MeSH), Femelle (MeSH), Groupes d'entraide (MeSH), Humains (MeSH), Infections à VIH (prévention et contrôle), Infections à VIH (psychologie), Infections à VIH (traitement médicamenteux), Infections à VIH (virologie), Jeune adulte (MeSH), Mâle (MeSH), Parents (MeSH), Politique publique (MeSH), République d'Afrique du Sud (MeSH), Résultat thérapeutique (MeSH), Soutien social (MeSH).
- MESH :
- prévention et contrôle : Infections à VIH.
- psychologie : Infections à VIH.
- traitement médicamenteux : Infections à VIH.
- virologie : Infections à VIH.
- Adhésion au traitement médicamenteux, Adolescent, Afrique de l'Est, Charge virale, Comportement de réduction des risques, Enfant, Femelle, Groupes d'entraide, Humains, Jeune adulte, Mâle, Parents, Politique publique, République d'Afrique du Sud, Résultat thérapeutique, Soutien social.
English descriptors
- KwdEn :
- Adolescent (MeSH), Africa, Eastern (MeSH), Child (MeSH), Female (MeSH), HIV Infections (drug therapy), HIV Infections (prevention & control), HIV Infections (psychology), HIV Infections (virology), Humans (MeSH), Male (MeSH), Medication Adherence (MeSH), Parents (MeSH), Public Policy (MeSH), Risk Reduction Behavior (MeSH), Self-Help Groups (MeSH), Social Support (MeSH), South Africa (MeSH), Treatment Outcome (MeSH), Viral Load (MeSH), Young Adult (MeSH).
- MESH :
- drug therapy : HIV Infections.
- prevention & control : HIV Infections.
- psychology : HIV Infections.
- virology : HIV Infections.
- Adolescent, Africa, Eastern, Child, Female, Humans, Male, Medication Adherence, Parents, Public Policy, Risk Reduction Behavior, Self-Help Groups, Social Support, South Africa, Treatment Outcome, Viral Load, Young Adult.
Abstract
Low 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.
DOI: 10.1080/09540121.2016.1179008
PubMed: 27392002
PubMed Central: PMC4991216
Affiliations:
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Toska</name><affiliation wicri:level="1"><nlm:affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford </wicri:regionArea><wicri:noRegion>Oxford </wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town , South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town </wicri:regionArea><wicri:noRegion>Cape Town </wicri:noRegion></affiliation></author><author><name sortKey="Orkin, F M" sort="Orkin, F M" uniqKey="Orkin F" first="F M" last="Orkin">F M Orkin</name><affiliation wicri:level="1"><nlm:affiliation>d DPHRU, School of Clinical Medicine, and DST-NRF Centre of Excellence in Human Development , University of the Witwatersrand , Johannesburg , South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>d DPHRU, School of Clinical Medicine, and DST-NRF Centre of Excellence in Human Development , University of the Witwatersrand , Johannesburg </wicri:regionArea><wicri:noRegion>Johannesburg </wicri:noRegion></affiliation></author><author><name sortKey="Meinck, F" sort="Meinck, F" uniqKey="Meinck F" first="F" last="Meinck">F. Meinck</name><affiliation wicri:level="1"><nlm:affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford </wicri:regionArea><wicri:noRegion>Oxford </wicri:noRegion></affiliation></author><author><name sortKey="Hodes, R" sort="Hodes, R" uniqKey="Hodes R" first="R" last="Hodes">R. Hodes</name><affiliation wicri:level="1"><nlm:affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford </wicri:regionArea><wicri:noRegion>Oxford </wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:affiliation>c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town , South Africa.</nlm:affiliation><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town </wicri:regionArea><wicri:noRegion>Cape Town </wicri:noRegion></affiliation></author><author><name sortKey="Yakubovich, A R" sort="Yakubovich, A R" uniqKey="Yakubovich A" first="A R" last="Yakubovich">A R Yakubovich</name><affiliation wicri:level="1"><nlm:affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford </wicri:regionArea><wicri:noRegion>Oxford </wicri:noRegion></affiliation></author><author><name sortKey="Sherr, L" sort="Sherr, L" uniqKey="Sherr L" first="L" last="Sherr">L. Sherr</name><affiliation wicri:level="1"><nlm:affiliation>e Health Psychology Unit, Research Department of Infection & Population Health, University College London , London , UK.</nlm:affiliation><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea>e Health Psychology Unit, Research Department of Infection & Population Health, University College London , London </wicri:regionArea><wicri:noRegion>London </wicri:noRegion></affiliation></author></analytic><series><title level="j">AIDS care</title><idno type="eISSN">1360-0451</idno><imprint><date when="2016" type="published">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term><term>Africa, Eastern (MeSH)</term><term>Child (MeSH)</term><term>Female (MeSH)</term><term>HIV Infections (drug therapy)</term><term>HIV Infections (prevention & control)</term><term>HIV Infections (psychology)</term><term>HIV Infections (virology)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Medication Adherence (MeSH)</term><term>Parents (MeSH)</term><term>Public Policy (MeSH)</term><term>Risk Reduction Behavior (MeSH)</term><term>Self-Help Groups (MeSH)</term><term>Social Support (MeSH)</term><term>South Africa (MeSH)</term><term>Treatment Outcome (MeSH)</term><term>Viral Load (MeSH)</term><term>Young Adult (MeSH)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adhésion au traitement médicamenteux (MeSH)</term><term>Adolescent (MeSH)</term><term>Afrique de l'Est (MeSH)</term><term>Charge virale (MeSH)</term><term>Comportement de réduction des risques (MeSH)</term><term>Enfant (MeSH)</term><term>Femelle (MeSH)</term><term>Groupes d'entraide (MeSH)</term><term>Humains (MeSH)</term><term>Infections à VIH (prévention et contrôle)</term><term>Infections à VIH (psychologie)</term><term>Infections à VIH (traitement médicamenteux)</term><term>Infections à VIH (virologie)</term><term>Jeune adulte (MeSH)</term><term>Mâle (MeSH)</term><term>Parents (MeSH)</term><term>Politique publique (MeSH)</term><term>République d'Afrique du Sud (MeSH)</term><term>Résultat thérapeutique (MeSH)</term><term>Soutien social (MeSH)</term></keywords><keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" qualifier="traitement médicamenteux" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="virologie" xml:lang="fr"><term>Infections à VIH</term></keywords><keywords scheme="MESH" qualifier="virology" xml:lang="en"><term>HIV Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adolescent</term><term>Africa, Eastern</term><term>Child</term><term>Female</term><term>Humans</term><term>Male</term><term>Medication Adherence</term><term>Parents</term><term>Public Policy</term><term>Risk Reduction Behavior</term><term>Self-Help Groups</term><term>Social Support</term><term>South Africa</term><term>Treatment Outcome</term><term>Viral Load</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adhésion au traitement médicamenteux</term><term>Adolescent</term><term>Afrique de l'Est</term><term>Charge virale</term><term>Comportement de réduction des risques</term><term>Enfant</term><term>Femelle</term><term>Groupes d'entraide</term><term>Humains</term><term>Jeune adulte</term><term>Mâle</term><term>Parents</term><term>Politique publique</term><term>République d'Afrique du Sud</term><term>Résultat thérapeutique</term><term>Soutien social</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Low 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.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" IndexingMethod="Curated" Owner="NLM"><PMID Version="1">27392002</PMID><DateCompleted><Year>2017</Year><Month>09</Month><Day>26</Day></DateCompleted><DateRevised><Year>2018</Year><Month>12</Month><Day>02</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">1360-0451</ISSN><JournalIssue CitedMedium="Internet"><Volume>28 Suppl 2</Volume><PubDate><Year>2016</Year><Month>03</Month></PubDate></JournalIssue><Title>AIDS care</Title></Journal><ArticleTitle>Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?</ArticleTitle><Pagination><MedlinePgn>73-82</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1080/09540121.2016.1179008</ELocationID><Abstract><AbstractText>Low 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.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Cluver</LastName><ForeName>L D</ForeName><Initials>LD</Initials><AffiliationInfo><Affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>b Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Toska</LastName><ForeName>E</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town , South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Orkin</LastName><ForeName>F M</ForeName><Initials>FM</Initials><AffiliationInfo><Affiliation>d DPHRU, School of Clinical Medicine, and DST-NRF Centre of Excellence in Human Development , University of the Witwatersrand , Johannesburg , South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Meinck</LastName><ForeName>F</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hodes</LastName><ForeName>R</ForeName><Initials>R</Initials><AffiliationInfo><Affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</Affiliation></AffiliationInfo><AffiliationInfo><Affiliation>c AIDS and Society Research Unit, Centre for Social Science Research , University of Cape Town , Cape Town , South Africa.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Yakubovich</LastName><ForeName>A R</ForeName><Initials>AR</Initials><AffiliationInfo><Affiliation>a Centre for Evidence-Based Intervention, Department of Social Policy and Intervention , University of Oxford , Oxford , UK.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sherr</LastName><ForeName>L</ForeName><Initials>L</Initials><AffiliationInfo><Affiliation>e Health Psychology Unit, Research Department of Infection & Population Health, University College London , London , UK.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>England</Country><MedlineTA>AIDS Care</MedlineTA><NlmUniqueID>8915313</NlmUniqueID><ISSNLinking>0954-0121</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><CitationSubset>X</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000351" MajorTopicYN="N">Africa, Eastern</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015658" MajorTopicYN="N">HIV Infections</DescriptorName><QualifierName UI="Q000188" MajorTopicYN="Y">drug therapy</QualifierName><QualifierName UI="Q000517" MajorTopicYN="N">prevention & control</QualifierName><QualifierName UI="Q000523" 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