Citation

Cluver L, Meinck F, Toska E, Orkin FM, Hodes RJ, Sherr L. AIDS 2018; 32(8): 975-983.

Affiliation

Department of Global Health, University College London, United Kingdom.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/QAD.0000000000001795

PMID

29547438

Abstract

OBJECTIVE(S): HIV-positive adolescents have low ART-adherence, with consequent increased risks of mortality, morbidity and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART-adherence with adolescent violence victimisation by caregivers, teachers, peers, community members, and healthcare providers. DESIGN AND METHODS: HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10-19 year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between non-adherence and 9 violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects.

RESULTS: Past-week self-reported ART non-adherence was 36%. Non-adherence correlated strongly with virologic failure (OR 2.3, CI 1.4-3.8) and symptomatic pulmonary tuberculosis (OR 1.49, CI 1.18·2.05). Four violence types were independently associated with non-adherence: physical abuse by caregivers (OR 1.5, CI 1.1-2.1); witnessing domestic violence (OR 1.8, CI 1.22-2.66); teacher violence (OR 1.51, CI 1.16-1.96,) and verbal victimisation by healthcare staff (OR 2.15, CI 1.59-2.93). Past-week non-adherence rose from 25% with no violence, to 73.5% with four types of violence exposure.

CONCLUSIONS: Violence exposures at home, school and clinic are major and cumulating risks for adolescent antiretroviral non-adherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.

Language: en