ABSTRACT
SETTING: Children and adolescents with HIV encounter challenges in initiation and adherence to antiretroviral therapy (ART). A community-based support intervention of structured home visits, aimed at improving initiation, adherence and treatment, was delivered by community health workers (CHWs) to children and adolescents newly diagnosed with HIV. OBJECTIVES: To 1) describe intervention delivery, 2) explore CHW, caregiver and adolescents' perceptions of the intervention, 3) identify barriers and facilitators to implementation, and 4) ascertain treatment outcomes at 12 months' post-HIV diagnosis. DESIGN: We drew upon: 1) semi-structured interviews (n = 22) with 5 adolescents, 11 caregivers and 6 CHWs, 2) 28 CHW field manuals, and 3) quantitative data for study participants (demographic information and HIV clinical outcomes). RESULTS: Forty-one children received at least a part of the intervention. Of those whose viral load was tested, 26 (n = 32, 81.3%) were virally suppressed. Interviewees felt that the intervention supported ART adherence and strengthened mental health. Facilitators to intervention delivery were convenience and rapport between CHWs and families. Stigma, challenges in locating participants and inadequate resources for CHWs were barriers. CONCLUSION: This intervention was helpful in supporting HIV treatment adherence among adolescents and children. Facilitators and barriers may be useful in developing future interventions.
CONTEXTE: Les enfants et les adolescents séropositifs rencontrent des difficultés dans l'initiation et l'adhésion à la thérapie antirétrovirale (TAR). Des agents de santé communautaires (CHW) ont mis en place une intervention de soutien communautaire sous forme de visites structurées à domicile visant à améliorer l'initiation, l'adhésion et le traitement, auprès d'enfants et d'adolescents nouvellement diagnostiqués séropositifs. OBJECTIFS: 1) Décrire la mise en Åuvre de l'intervention, 2) explorer les perceptions de l'intervention par les CHW, les soignants et les adolescents, 3) identifier les obstacles et les facilitateurs de la mise en Åuvre, et 4) vérifier les résultats du traitement 12 mois après le diagnostic du VIH. METHODES: Nous nous sommes appuyés sur 1) des entretiens semi-structurés (n = 22) avec 5 adolescents, 11 soignants et 6 CHW, 2) 28 manuels de terrain des CHW, et 3) des données quantitatives sur les participants à l'étude (informations démographiques et résultats cliniques du VIH). RÉSULTATS: Quarante et un enfants ont reçu au moins une partie de l'intervention. Parmi ceux dont la charge virale a été testée, 26 (n = 32 ; 81,3%) étaient sous suppression virale. Les personnes interrogées ont estimé que l'intervention soutenait l'adhésion au TAR et renforçait la santé mentale. Les facilitateurs de la mise en Åuvre de l'intervention étaient la commodité et les rapports entre les CHW et les familles. La stigmatisation, les difficultés à trouver des participants et les ressources inadéquates pour les CHW étaient des obstacles. CONCLUSION: Cette intervention a été utile pour soutenir l'adhésion au traitement du VIH chez les adolescents et les enfants. Les facilitateurs et les obstacles peuvent être utiles pour développer de futures interventions.
ABSTRACT
South Africa's HIV prevalence among young people remains among the highest in the world. A cross-sectional study was carried out in 2012 to estimate prevalences of sexual risk behavior and hazardous alcohol use (HAU) (via the Alcohol Use Disorder Identification Test) as well as to investigate potential associations between these outcomes and social media use. In all, 4485 students (mean age 15.66 years, SD 1.39) at 46 secondary schools in informal settlements in Cape Town and Port Elizabeth completed mobile-phone-assisted, self-administered baseline questionnaires within a cluster-randomized trial. In all, 312 females (12.5 %) and 468 males (23.5 %) screened positive for HAU (AOR = 1.98, 95 % CI 1.69-2.34). 730 males (39.9 %) and 268 females (11.8 %) reported having had two or more partners in the last year (AOR = 3.46, 95 % CI 2.87-4.16). Among females, having a Facebook account was associated with reported multiple partnerships in the last year (AOR = 1.81, 95 % CI 1.19-2.74), age-disparate sex in the last year (AOR = 1.96, 95 % CI 1.16-3.32) and HAU (AOR = 1.97, 95 % CI 1.41-2.74). Using Mxit-a popular mobile instant messaging application-was associated with higher odds of reported multiple partnerships in the last year among both males (AOR = 1.70, 95 % CI 1.35-2.14) and females (AOR = 1.45, 95 % CI 1.07-1.96) and with HAU among both males (AOR = 1.47, 95 % CI 1.14-1.90) and females (AOR = 1.50, 95 % CI 1.18-1.90). Further longitudinal and qualitative research should explore in more depth the observed links between social media and risk behavior.
