SidaSubSaharaV1, Pmc, Corpus, bibRecord, 001757

Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda

Identifieur interne : 001757 ( Pmc/Corpus ); précédent : 001756; suivant : 001758

Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda

Auteurs : Mary C. Smith Fawzi ; Lauren Ng ; Fredrick Kanyanganzi ; Catherine Kirk ; Justin Bizimana ; Felix Cyamatare ; Christina Mushashi ; Taehoon Kim ; Yvonne Kayiteshonga ; Agnes Binagwaho ; Theresa S. Betancourt

Source :

Pediatrics [ 0031-4005 ] ; 2016.

RBID : PMC:5051202

Abstract

BACKGROUND AND OBJECTIVES:

In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda.

METHODS:

A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (n = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence.

RESULTS:

Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55–5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01–1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms.

CONCLUSIONS:

The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.

Url:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5051202

DOI: 10.1542/peds.2015-3235
PubMed: 27677570
PubMed Central: 5051202

Links to Exploration step

PMC:5051202

Le document en format XML

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<author><name sortKey="Smith Fawzi, Mary C" sort="Smith Fawzi, Mary C" uniqKey="Smith Fawzi M" first="Mary C." last="Smith Fawzi">Mary C. Smith Fawzi</name>
<affiliation><nlm:aff id="aff1">Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ng, Lauren" sort="Ng, Lauren" uniqKey="Ng L" first="Lauren" last="Ng">Lauren Ng</name>
<affiliation><nlm:aff id="aff2">Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kanyanganzi, Fredrick" sort="Kanyanganzi, Fredrick" uniqKey="Kanyanganzi F" first="Fredrick" last="Kanyanganzi">Fredrick Kanyanganzi</name>
<affiliation><nlm:aff id="aff3">Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kirk, Catherine" sort="Kirk, Catherine" uniqKey="Kirk C" first="Catherine" last="Kirk">Catherine Kirk</name>
<affiliation><nlm:aff id="aff4">Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bizimana, Justin" sort="Bizimana, Justin" uniqKey="Bizimana J" first="Justin" last="Bizimana">Justin Bizimana</name>
<affiliation><nlm:aff id="aff5">Ministry of Health, Government of Rwanda, Kigali, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cyamatare, Felix" sort="Cyamatare, Felix" uniqKey="Cyamatare F" first="Felix" last="Cyamatare">Felix Cyamatare</name>
<affiliation><nlm:aff id="aff3">Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mushashi, Christina" sort="Mushashi, Christina" uniqKey="Mushashi C" first="Christina" last="Mushashi">Christina Mushashi</name>
<affiliation><nlm:aff id="aff3">Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kim, Taehoon" sort="Kim, Taehoon" uniqKey="Kim T" first="Taehoon" last="Kim">Taehoon Kim</name>
<affiliation><nlm:aff id="aff1">Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kayiteshonga, Yvonne" sort="Kayiteshonga, Yvonne" uniqKey="Kayiteshonga Y" first="Yvonne" last="Kayiteshonga">Yvonne Kayiteshonga</name>
<affiliation><nlm:aff id="aff5">Ministry of Health, Government of Rwanda, Kigali, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Binagwaho, Agnes" sort="Binagwaho, Agnes" uniqKey="Binagwaho A" first="Agnes" last="Binagwaho">Agnes Binagwaho</name>
<affiliation><nlm:aff id="aff1">Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</nlm:aff>
</affiliation>
<affiliation><nlm:aff wicri:cut="; and" id="aff6">Dartmouth College, Hanover, New Hampshire</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff7">University of Global Health Equity, Kigali, Rwanda</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Betancourt, Theresa S" sort="Betancourt, Theresa S" uniqKey="Betancourt T" first="Theresa S." last="Betancourt">Theresa S. Betancourt</name>
<affiliation><nlm:aff id="aff4">Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda</title>
<author><name sortKey="Smith Fawzi, Mary C" sort="Smith Fawzi, Mary C" uniqKey="Smith Fawzi M" first="Mary C." last="Smith Fawzi">Mary C. Smith Fawzi</name>
<affiliation><nlm:aff id="aff1">Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Ng, Lauren" sort="Ng, Lauren" uniqKey="Ng L" first="Lauren" last="Ng">Lauren Ng</name>
<affiliation><nlm:aff id="aff2">Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kanyanganzi, Fredrick" sort="Kanyanganzi, Fredrick" uniqKey="Kanyanganzi F" first="Fredrick" last="Kanyanganzi">Fredrick Kanyanganzi</name>
<affiliation><nlm:aff id="aff3">Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kirk, Catherine" sort="Kirk, Catherine" uniqKey="Kirk C" first="Catherine" last="Kirk">Catherine Kirk</name>
<affiliation><nlm:aff id="aff4">Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Bizimana, Justin" sort="Bizimana, Justin" uniqKey="Bizimana J" first="Justin" last="Bizimana">Justin Bizimana</name>
<affiliation><nlm:aff id="aff5">Ministry of Health, Government of Rwanda, Kigali, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Cyamatare, Felix" sort="Cyamatare, Felix" uniqKey="Cyamatare F" first="Felix" last="Cyamatare">Felix Cyamatare</name>
<affiliation><nlm:aff id="aff3">Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Mushashi, Christina" sort="Mushashi, Christina" uniqKey="Mushashi C" first="Christina" last="Mushashi">Christina Mushashi</name>
<affiliation><nlm:aff id="aff3">Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kim, Taehoon" sort="Kim, Taehoon" uniqKey="Kim T" first="Taehoon" last="Kim">Taehoon Kim</name>
<affiliation><nlm:aff id="aff1">Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kayiteshonga, Yvonne" sort="Kayiteshonga, Yvonne" uniqKey="Kayiteshonga Y" first="Yvonne" last="Kayiteshonga">Yvonne Kayiteshonga</name>
<affiliation><nlm:aff id="aff5">Ministry of Health, Government of Rwanda, Kigali, Rwanda;</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Binagwaho, Agnes" sort="Binagwaho, Agnes" uniqKey="Binagwaho A" first="Agnes" last="Binagwaho">Agnes Binagwaho</name>
<affiliation><nlm:aff id="aff1">Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</nlm:aff>
</affiliation>
<affiliation><nlm:aff wicri:cut="; and" id="aff6">Dartmouth College, Hanover, New Hampshire</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="aff7">University of Global Health Equity, Kigali, Rwanda</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Betancourt, Theresa S" sort="Betancourt, Theresa S" uniqKey="Betancourt T" first="Theresa S." last="Betancourt">Theresa S. Betancourt</name>
<affiliation><nlm:aff id="aff4">Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Pediatrics</title>
<idno type="ISSN">0031-4005</idno>
<idno type="eISSN">1098-4275</idno>
<imprint><date when="2016">2016</date>
</imprint>
</series>
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<front><div type="abstract" xml:lang="en"><sec id="s01"><title>BACKGROUND AND OBJECTIVES:</title>
<p>In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda.</p>
</sec>
<sec id="s02"><title>METHODS:</title>
<p>A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (<italic>n</italic>
 = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence.</p>
</sec>
<sec id="s03"><title>RESULTS:</title>
<p>Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55–5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01–1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms.</p>
</sec>
<sec id="s04"><title>CONCLUSIONS:</title>
<p>The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.</p>
</sec>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
  <front><journal-meta><journal-id journal-id-type="nlm-ta">Pediatrics</journal-id>
<journal-id journal-id-type="iso-abbrev">Pediatrics</journal-id>
<journal-id journal-id-type="hwp">pediatrics</journal-id>
<journal-id journal-id-type="pmc">pediatrics</journal-id>
<journal-id journal-id-type="publisher-id">Pediatrics</journal-id>
<journal-title-group><journal-title>Pediatrics</journal-title>
</journal-title-group>
<issn pub-type="ppub">0031-4005</issn>
<issn pub-type="epub">1098-4275</issn>
<publisher><publisher-name>American Academy of Pediatrics</publisher-name>
<publisher-loc>Elk Grove Village, IL, USA</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27677570</article-id>
<article-id pub-id-type="pmc">5051202</article-id>
<article-id pub-id-type="publisher-id">peds.2015-3235</article-id>
<article-id pub-id-type="doi">10.1542/peds.2015-3235</article-id>
<article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>32.00</subject>
<subject>32.02</subject>
<subject>3.00</subject>
</subj-group>
<subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Smith Fawzi</surname>
<given-names>Mary C.</given-names>
</name>
<degrees>ScD</degrees>
<xref ref-type="aff" rid="aff1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ng</surname>
<given-names>Lauren</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff2">b</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kanyanganzi</surname>
<given-names>Fredrick</given-names>
</name>
<degrees>MBA</degrees>
<xref ref-type="aff" rid="aff3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kirk</surname>
<given-names>Catherine</given-names>
</name>
<degrees>MPH</degrees>
<xref ref-type="aff" rid="aff4">d</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bizimana</surname>
<given-names>Justin</given-names>
</name>
<degrees>MS</degrees>
<xref ref-type="aff" rid="aff5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cyamatare</surname>
<given-names>Felix</given-names>
</name>
<degrees>MD</degrees>
<degrees>MPH</degrees>
<xref ref-type="aff" rid="aff3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Mushashi</surname>
<given-names>Christina</given-names>
</name>
<degrees>BS</degrees>
<xref ref-type="aff" rid="aff3">c</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kim</surname>
<given-names>Taehoon</given-names>
</name>
<degrees>BS</degrees>
<xref ref-type="aff" rid="aff1">a</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kayiteshonga</surname>
<given-names>Yvonne</given-names>
</name>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff5">e</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Binagwaho</surname>
<given-names>Agnes</given-names>
</name>
<degrees>MD</degrees>
<degrees>PhD</degrees>
<xref ref-type="aff" rid="aff1">a</xref>
<xref ref-type="aff" rid="aff6">f</xref>
<xref ref-type="aff" rid="aff7">g</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Betancourt</surname>
<given-names>Theresa S.</given-names>
</name>
<degrees>ScD</degrees>
<degrees>MA</degrees>
<xref ref-type="aff" rid="aff4">d</xref>
</contrib>
<aff id="aff1"><label>a</label>
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;</aff>
<aff id="aff2"><label>b</label>
Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts;</aff>
<aff id="aff3"><label>c</label>
Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH/IMB), Rwinkwavu, Rwanda;</aff>
<aff id="aff4"><label>d</label>
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;</aff>
<aff id="aff5"><label>e</label>
Ministry of Health, Government of Rwanda, Kigali, Rwanda;</aff>
<aff id="aff6"><label>f</label>
Dartmouth College, Hanover, New Hampshire; and</aff>
<aff id="aff7"><label>g</label>
University of Global Health Equity, Kigali, Rwanda</aff>
</contrib-group>
<author-notes><corresp id="cor8">Address correspondence to Mary C. Smith Fawzi, ScD, Harvard Medical School, Department of Global Health and Social Medicine, 641 Huntington Ave, Boston, MA 02115. E-mail: <email>mary_smith-fawzi@hms.harvard.edu</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub"><month>10</month>
<year>2016</year>
</pub-date>
<volume>138</volume>
<issue>4</issue>
<elocation-id>e20153235</elocation-id>
<history><date date-type="accepted"><day>14</day>
<month>7</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2016 by the American Academy of Pediatrics</copyright-statement>
<copyright-year>2016</copyright-year>
</permissions>
<self-uri xlink:title="pdf" xlink:href="PEDS_20153235.pdf"></self-uri>
<abstract><sec id="s01"><title>BACKGROUND AND OBJECTIVES:</title>
<p>In Rwanda, significant progress has been made in advancing access to antiretroviral therapy (ART) among youth. As availability of ART increases, adherence is critical for preventing poor clinical outcomes and transmission of HIV. The goals of the study are to (1) describe ART adherence and mental health problems among youth living with HIV aged 10 to 17; and (2) examine the association between these factors among this population in rural Rwanda.</p>
</sec>
<sec id="s02"><title>METHODS:</title>
<p>A cross-sectional analysis was conducted that examined the association of mental health status and ART adherence among youth (<italic>n</italic>
 = 193). ART adherence, mental health status, and related variables were examined based on caregiver and youth report. Nonadherence was defined as ever missing or refusing a dose of ART within the past month. Multivariate modeling was performed to examine the association between mental health status and ART adherence.</p>
</sec>
<sec id="s03"><title>RESULTS:</title>
<p>Approximately 37% of youth missed or refused ART in the past month. In addition, a high level of depressive symptoms (26%) and attempt to hurt or kill oneself (12%) was observed in this population of youth living with HIV in Rwanda. In multivariate analysis, nonadherence was significantly associated with some mental health outcomes, including conduct problems (odds ratio 2.90, 95% confidence interval 1.55–5.43) and depression (odds ratio 1.02, 95% confidence interval 1.01–1.04), according to caregiver report. A marginally significant association was observed for youth report of depressive symptoms.</p>
</sec>
<sec id="s04"><title>CONCLUSIONS:</title>
<p>The findings suggest that mental health should be considered among the factors related to ART nonadherence in HIV services for youth, particularly for mental health outcomes, such as conduct problems and depression.</p>
</sec>
</abstract>
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Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda

Mental Health and Antiretroviral Adherence Among Youth Living With HIV in Rwanda

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