Advertisement

AIDS and Behavior

, Volume 23, Issue 2, pp 513–522 | Cite as

Virological Non-suppression and Its Correlates Among Adolescents and Young People Living with HIV in Southern Malawi

  • Eric UmarEmail author
  • Judith A. Levy
  • Robert C. Bailey
  • Geri Donenberg
  • Ronald C. Hershow
  • Mary Ellen Mackesy-Amiti
Original Paper

Abstract

We examined virological non-suppression (VLN) among youth ages 13–24 years receiving HIV treatment in public health facilities in six southern Malawi districts. We also tested three ART adherence measures to determine how well each identified VLN: pill counts, a Likert scale item, and a visual analogue scale. VLN was defined as HIV RNA > 1000 copies/ml. Of the 209 youth, 81 (39%) were virally non-suppressed. Male gender and stigma were independently associated with VLN; social support and self-efficacy were independently protective. Pill count had the highest positive predictive value (66.3%). Using a pill count cut-off of < 80% nonadherence, 36 (17%) of the youth were non-adherent. Of the adherent, 120 (69%) were viral suppressed. Results indicate the need to address HIV-related stigma and to bolster social support and selfefficacy in order to enhance viral suppression. In the absence of viral load testing, pill count appears the most accurate means to assess VLN.

Keywords

HIV/AIDS Antiretroviral therapy Adolescent Virological non-suppression Adherence 

Notes

Acknowledgements

We thank the study’s participants for their time and participation. We also are grateful to the health providers at each district hospital for their help in recruiting our study sample. Support for the study was provided through a dissertation award to the senior author by the UIC AIDS International Training and Research Program through funding from the John E. Fogarty International Center of the National Institutes of Health (D43 TW001419).

Funding

This study was funded by Fogarty AIDS International Training and Research Program (AITRP) (Grant No.: D43 TW001419).

Compliance with Ethical Standards

Conflict of interest

All authors declare no conflict of interest.

Ethical Approval

Study procedures, instruments, and all materials were reviewed and approved by the Institutional Review Boards of the University of Illinois at Chicago and the University of Malawi’s College of Medicine Research and Ethics Committee. All procedures involving human participants were conducted in accord with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Voluntary informed consent was obtained from those participants who were 18-24 years of age and both assent and parental permission from those ages 13-17.

References

  1. 1.
    Slogrove AL, Sohn AH. The global epidemiologyof adolescents living with HIV: time for more granular data to improve adolescent health outcomes. Curr Opin HIV AIDS. 2018;13(3):170–8.Google Scholar
  2. 2.
    Kim MH, Mazenga AC, Yu X, et al. High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors. J Int AIDS Soc. 2017;20(1):1–12.CrossRefGoogle Scholar
  3. 3.
    Bulage L, Ssewanyana I, Nankabirwa V, et al. Factors associated with virological non-suppression among HIV-positive patients on antiretroviral therapy in Uganda August 2014–July 2015. BMC Infect Dis. 2017;17(1):326.CrossRefGoogle Scholar
  4. 4.
    Dworkin MS, Douglas GW, Sabilha Rani GP, Chakraborty A. Adherence to highly active antiretroviral therapy in Hyderabad, India: barriers, facilitators and identification of target groups. Int J STD AIDS. 2016;27(3):186–95.CrossRefGoogle Scholar
  5. 5.
    Shubber Z, Mills EJ, Nachega JB, et al. Patient-reported barriers to adherence to antiretroviral therapy: a systematic review and meta-analysis. PLoS Med. 2016;13(11):e1002183.CrossRefGoogle Scholar
  6. 6.
    Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care. 2015;27(7):805–16.CrossRefGoogle Scholar
  7. 7.
    Ramaiya MK, Sullivan KA, O’Donnell K, et al. A qualitative exploration of the mental health and psychosocial contexts of HIV-positive adolescents in Tanzania. PLoS ONE. 2016;11(11):e0165936.CrossRefGoogle Scholar
  8. 8.
    Folayan M, Odetoyinbo Morolake, Brown B, Harrison A, et al. Addressing the socio-development needs of adolescents living with HIV/AIDS in Nigeria: a call for action. Afr J Reprod Health. 2014;18(3):93–101.Google Scholar
  9. 9.
    Kacanek D, Angelidou K, Williams PL, Chernoff M, Gadow KD, Nachman S. Psychiatric symptoms and antiretroviral nonadherence in US youth with perinatal HIV: a longitudinal study. AIDS. 2015;29(10):1227–37.CrossRefGoogle Scholar
  10. 10.
    Denison JA, Banda H, Dennis AC, et al. “The sky is the limit”: adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their adult caregivers. J Int AIDS Soc. 2015;13(18):19358.CrossRefGoogle Scholar
  11. 11.
    Kang E, Delzel DA, Chhabra M, Oberdorfer P. Factors associated with high rates of antiretroviral medication adherence among youth living with perinatal HIV in Thailand. Int J STD AIDS. 2015;26(8):534–41.CrossRefGoogle Scholar
  12. 12.
    Xu L, Munir K, Kanabkaew C, Le Coeur S. Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand. PLoS ONE. 2017;12(2):e0172392.CrossRefGoogle Scholar
  13. 13.
    MacDonell KK, Jacques-Tiura AJ, Naar S, Fernandez MI. Predictors of self-reported adherence to antiretroviral medication in a multisite study of ethnic and racial minority HIV-positive youth. J Pediatr Psychol. 2016;41(4):419–28.CrossRefGoogle Scholar
  14. 14.
    Ewart CK. Social action theory for a public health psychology. Am Psychol. 1991;46(9):931–46.CrossRefGoogle Scholar
  15. 15.
    Traube DE, Holloway IW, Schrager SM, Kipke MD. Utilizing Social Action Theory as a framework to determine correlates of illicit drug use among young men who have sex with men. Psychol Addict Behav. 2012;26(1):78–88.CrossRefGoogle Scholar
  16. 16.
    Avert. HIV and AIDS in Malawi. 2015 01 May 2015 (cited 2015 30 December); http://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/malawi.
  17. 17.
    Stewart RC, Umar E, Tomenson B, Creed F. Validation of screening tools for antenatal depression in Malawi–a comparison of the Edinburgh postnatal depression scale and self reporting questionnaire. J Affect Disord. 2013;150(3):1041–7.CrossRefGoogle Scholar
  18. 18.
    Holzemer WL, Uys LR, Chirwa ML, et al. Validation of the HIV/AIDS stigma instrument—PLWA (HASI-P). AIDS Care. 2007;19(8):1002–12.CrossRefGoogle Scholar
  19. 19.
    Stewart RC, Umar E, Tomenson B, Creed F. Validation of the multi-dimensional scale of perceived social support (MSPSS) and the relationship between social support, intimate partner violence and antenatal depression in Malawi. BMC Psychiatry. 2014;14:180.CrossRefGoogle Scholar
  20. 20.
    Nakimuli-Mpungu E, Mojtabai R, Alexandre PK, et al. Lifetime depressive disorders and adherence to anti-retroviral therapy in HIV-infected Ugandan adults: a case-control study. J Affect Disord. 2013;145(2):221–6.CrossRefGoogle Scholar
  21. 21.
    Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The role of self-efficacy in HIV treatment adherence: validation of the HIV treatment adherence self-efficacy scale (HIV-ASES). J Behav Med. 2007;30(5):359–70.CrossRefGoogle Scholar
  22. 22.
    Douglas GP, Gadabu OJ, Joukes S, et al. Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi. PLoS Med. 2010;7(8):e1000319.CrossRefGoogle Scholar
  23. 23.
    Feldman BJ, Fredericksen RJ, Crane PK, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17(1):307–18.CrossRefGoogle Scholar
  24. 24.
    Bezabhe WM, Charmers L, Bereznicki LR, Peterson GM. Adherence to antiretroviral therapy and virologic failure: a meta-analysis. Medicine (Baltimore). 2016;95(15):e3361.CrossRefGoogle Scholar
  25. 25.
    Centers for Disease Control and Prevention (CDC), ICAP, Columbia University Mailman School of Public Health, Johns Hopkins University, Ministry of Health (Malawi), Statistical Center for HIV/AIDS Research and Prevention (SCHARP), University of Malawi College of Medicine, Westat. Malawi Population-Based HIV Impact Assessment 2015–2016. 2016.Google Scholar
  26. 26.
    Smith C, Gengiah TN, Yende-Zuma N, Upfold M, Naidoo K. Assessing adherence to antiretroviral therapy in a rural paediatric cohort in KwaZulu-Natal, South Africa. AIDS Behav. 2016;20(11):2729–38.CrossRefGoogle Scholar
  27. 27.
    Kerschberger B, Boulle AM, Kranzer K. Superior virologic and treatment outcomes when viral load is measured at 3 months compared to 6 months on antiretroviral therapy. J Int AIDS Soc. 2015;18:20092.CrossRefGoogle Scholar
  28. 28.
    Zanoni BC, Archary M, Buchan S, Katz IT, Haberer JE. Systematic review and meta-analysis of the adolescent HIV continuum of care in South Africa: the cresting wave. BMJ Global Health. 2016;1(3):e000004.CrossRefGoogle Scholar
  29. 29.
    Cruz ML, Cardoso CA, Darmont MQ, et al. Viral suppression and adherence among HIV-infected children and adolescents on antiretroviral therapy: results of a multicenter study. J Pediatr (Rio J). 2014;90(6):563–71.CrossRefGoogle Scholar
  30. 30.
    Saberi P, Mayer K, Vittinghoff E, Naar-King S. Correlation between use of antiretroviral adherence devices by HIV-infected youth and plasma HIV RNA and self-reported adherence. AIDS Behav. 2015;19(1):93–103.CrossRefGoogle Scholar
  31. 31.
    Burch LS, Smith CJ, Anderson J, et al. Socioeconomic status and treatment outcomes for individuals with HIV on antiretroviral treatment in the UK: cross-sectional and longitudinal analyses. Lancet Public Health. 2016;1(1):e26–36.CrossRefGoogle Scholar
  32. 32.
    Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.CrossRefGoogle Scholar
  33. 33.
    Sutton SS, Magagnoli J, Hardin JW. Odds of viral suppression by single-tablet regimens, multiple-tablet regimens, and adherence level in HIV/AIDS patients receiving antiretroviral therapy. Pharmacotherapy. 2017;37(2):204–13.CrossRefGoogle Scholar
  34. 34.
    Boily MC, Masse B, Alsallag R, et al. HIV treatment as prevention: considerations in the design, conduct, and analysis of cluster randomized controlled trials of combination HIV prevention. PLoS Med. 2012;9(7):e1001250.CrossRefGoogle Scholar
  35. 35.
    Mave V, Gahunia M, Frontini M, Clark R, Mushatt D. Gender differences in HIV drug resistance mutations and virological outcome. J Womens Health (Larchmt). 2011;20(1):117–22.CrossRefGoogle Scholar
  36. 36.
    Sumari-de Boer IM, Sprangers MA, Prins JM, Nieuwkerk PT. HIV stigma and depressive symptoms are related to adherence and virological response to antiretroviral treatment among immigrant and indigenous HIV infected patients. AIDS Behav. 2012;16(6):1681–9.CrossRefGoogle Scholar
  37. 37.
    Croome N, Ahluwalia M, Hughes LD, Abas M. Patient-reported barriers and facilitators to antiretroviral adherence in Sub-Saharan Africa: a systematic review. AIDS. 2017;31(7):995–1007.CrossRefGoogle Scholar
  38. 38.
    Tran BX, Nguyen LT, Nguyen NH, Hoang QV, Hwang J. Determinants of antiretroviral treatment adherence among HIV/AIDS patients: a multisite study. Glob Health Action. 2013;6:19570.CrossRefGoogle Scholar
  39. 39.
    Reif S, Proeschold-Bell RJ, Yao J, et al. Three types of self-efficacy associated with medication adherence in patients with co-occurring HIV and substance use disorders, but only when mood disorders are present. J Multidiscip Healthc. 2013;6:229–37.Google Scholar
  40. 40.
    Abrams EJ, Strasser S, Kranzer K. 90-90-90—Charting a steady course to end the paediatric HIV epidemic. J Int AIDS Soc. 2015;18:20096.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Health Systems and PolicyUniversity of MalawiBlantyreMalawi
  2. 2.University of Malawi, College of MedicineBlantyre 3Malawi
  3. 3.Department of Health Policy and AdministrationUniversity of Illinois at ChicagoChicagoUSA
  4. 4.Department of Epidemiology and BiostaticsUniversity of Illinois at ChicagoChicagoUSA

Personalised recommendations