The impact of COVID-19 on HIV treatment of adolescents in sub-Saharan Africa: A scoping review

Background: Adolescents living with HIV are a key population who are susceptible to poor health. The global coronavirus disease 2019 pandemic and widespread national COVID-19 restrictions has disrupted health service delivery and HIV support services, affecting treatment adherence among adolescents with HIV. Aim: This study aimed to review the available literature on the impact of the COVID-19 pandemic on the HIV treatment of adolescents in sub-Saharan Africa. Method: Seven online databases were searched for articles published between 2020 and 2022 that focused on the impact of COVID-19 on adolescents living with HIV on antiretroviral therapy. A data charting extraction form and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) flowchart were used for screening and reporting the articles in this review. A narrative synthesis was conducted. Results: Five overarching themes emerged from the articles in this review, which highlighted the mental, social, and economic impacts of the COVID-19 pandemic, as well as the impact of the reallocation of healthcare services and challenges to accessing HIV care services on the antiretroviral therapy (ART) adherence of adolescents living with HIV. Conclusion: The global COVID-19 pandemic affected adolescents living with HIV in sub-Saharan Africa in many ways, but very little research has been done to describe the various ways in which the physical and mental well-being of adolescents were impacted.

Social and economic barriers to adherence among patients at Livingstone general hospital in Zambia

Background: Zambia is one of the countries hardest hit by the HIV (HIV) and acquired immune deficiency syndrome (AIDS) pandemic with a national HIV prevalence estimated at 14% among those aged 15­49 years in 2012. Antiretroviral therapy (ART) has been available in public health facilities in Zambia since 2003. By early 2016, 65% of the 1.2 million Zambians living with HIV were accessing ART. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally. Aim: This article reports on social and economic barriers to ART adherence among HIV patients being attended to at Livingstone General Hospital in Zambia.Setting: Livingstone General Hospital is located in the Southern province of Zambia, and had over 7000 patients enrolled for HIV care of whom 3880 patients were on ART.Methods: An explorative, qualitative study was conducted with 42 patients on ART where data were collected through six focus group discussions (3 male and 3 female groups) and seven in-depth interviews. Data were audio-recorded and transcribed verbatim and subjected to thematic content analysis. Results: Economic factors such as poverty and unemployment and the lack of food were reported as major barriers to adherence. Furthermore, social factors such as traditional medicine, religion, lack of family and partner support, and disclosure were also reported as critical barriers to adherence to ART.Conclusion: Interventions to improve adherence among ART patients should aim to redress the socio-economic challenges at community and individual levels

Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals

Background: Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas.Objective: To explore health care workers' perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa.Methods: An explorative descriptive qualitative study was conducted. Four focus group discussions were held with 33 hospital staff (senior clinical and management staff, and junior clinical staff) using interview guide questions developed based on the findings from an epidemiological study that was conducted in the same hospitals. Qualitative data were analysed using the framework analysis.Findings: Most respondents believed that critical illness, which was related to early and high case fatality rates on admission, was linked to a web of factors including preference for traditional medicine over conventional care, gross negligence of the child at household level, misdiagnosis of severe malnutrition at the first point of care, lack of specialised skills to deal with complex presentations, shortage of patient beds in the hospital and policies to discharge patients before optimal recovery. The majority believed that the WHO guidelines were effective and relatively simple to implement, but that they do not make much difference among severe acute malnutrition cases that are admitted in a critical condition. Poor management of cases was linked to the lack of continuity in training of rotating clinicians, sporadic shortages of therapeutic resources, inadequate staffing levels after normal working hours and some organisational and system-wide challenges beyond the immediate control of clinicians.Conclusion: Findings from this study suggest that effective management of paediatric severe acute malnutrition in the study setting is affected by a multiplicity of factors that manifest at different levels of the health system and the community. A verificatory study is encouraged to collaborate these findings

Patients' Knowledge and Beliefs about Antiretroviral Treatment and Factors Associated with Adherence in Mpumalanga Province; South Africa

Background: Antiretroviral treatment (ART) improves the prognosis and quality of life for HIV patients by reducing the rate of disease progression and mortality. Although ART has been available in public health centres in South Africa since 2003; adherence to treatment still remains a challenge. To date; no study has investigated adherence and the factors that influence adherence to ART in rural settings in Mpumalanga Province.Objective: This study described adherence to; knowledge and beliefs about ART and other factors associated with adherence amongst patients registered at Shongwe Hospital in Nkomazi Local Municipality. Method: A cross-sectional survey of 184 randomly selected patients on ART between ages of 15 and 65 years was conducted. Results: The respondents completed a questionnaire on self-reported adherence; knowledge and beliefs about ART and other factors associated with adherence. The majority of the respondents were female (71.2) and unemployed (83.7). Most respondents reported optimal ART adherence (taking 95 or more of their medication as prescribed) over the past two (92.4) and seven (84.2) days; respectively. The level of knowledge about ART was high and most reported positive beliefs about the effectiveness of ART. However; slightly more than half (53.3) believed that ART was harmful for the body. The most commonly-reported reasons for missing dosages were forgetfulness; business of the daily routine; having visitors; 'visiting a bar' and sleeping away from home.Conclusion: Although; the study found that most ART patients at Shongwe Hospital reported optimal adherence initially; the reasons for missing dosages; some incorrect knowledge and beliefs need to be addressed to ensure long-term adherence and persistence in care