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Barriers to Retention in Care are Overcome by Adolescent-Friendly Services for Adolescents Living with HIV in South Africa: A Qualitative Analysis

  • Brian C. Zanoni
  • Thobekile Sibaya
  • Chelline Cairns
  • Jessica E. Haberer
Original Paper
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Abstract

To assess facilitators and barriers to retention in care for adolescents living with HIV, we conducted in-depth, semi-structured interviews with adolescents ages 13 to 24 years who were living with HIV and being cared for in either an adolescent-friendly or standard government-supported clinic in KwaZulu-Natal, South Africa. We used inductive content analysis approach based on grounded theory derived from reviewing, coding, and interpreting data. We interviewed 28 adolescents living with HIV (16 in the adolescent clinic and 12 from the pediatric clinic) and 14 of their caregivers. Barriers to retention in care included having to attend clinic during school hours, fear of disclosure to others, social isolation, and conflict with clinical staff. Facilitators to retention in care seen in the adolescent-friendly services clinic included after school clinic hours, peer support, and connection to the clinical staff. Adolescent-friendly services are facilitators of HIV care and warrant prioritization in treatment programs.

Keywords

Adolescents Adolescent-friendly Retention in care HIV 

Notes

Funding

This study was funded by T32 AI 007433.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Durban University of Technology Independent Review Committee, KwaZulu-Natal Department of Health, and the Partners/Massachusetts General Hospital Research Ethics Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Zanoni BA, Archary M, Buchan S, Katz I, Haberer J. Systematic review and meta-analysis of the adolescent and young adult HIV continuum of care in South Africa: the cresting wave. BMJ Global Health. 2016;1(3):e000004.  https://doi.org/10.1136/bmjgh-2015-000004).CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Denison JA, Packer C, Stalter RM, Banda H, Mercer S, Nyambe N, et al. Factors related to incomplete adherence to antiretroviral therapy among adolescents attending three HIV clinics in the copperbelt, Zambia. AIDS Behav. 2017.  https://doi.org/10.1007/s10461-017-1944-x.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Hogwood J, Campbell T, Butler S. I wish I could tell you but I can’t: adolescents with perinatally acquired HIV and their dilemmas around self-disclosure. Clin Child Psychol Psychiatry. 2013;18(1):44–60.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Koenig LJ, Nesheim S, Abramowitz S. Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors. Curr Opin Obstet Gynecol. 2011;23(5):321–7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Maskew M, Brennan AT, MacPhail AP, Sanne IM, Fox MP. Poorer ART outcomes with increasing age at a large public sector HIV clinic in Johannesburg, South Africa. J Int Assoc Physicians AIDS Care (Chic). 2012;11(1):57–65.CrossRefGoogle Scholar
  6. 6.
    Evans D, Menezes C, Mahomed K, Macdonald P, Untiedt S, Levin L, et al. Treatment outcomes of HIV-infected adolescents attending public-sector HIV clinics across Gauteng and Mpumalanga, South Africa. AIDS Res Hum Retroviruses. 2013;29(6):892–900.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Mutevedzi PC, Lessells RJ, Rodger AJ, Newell ML. Association of age with mortality and virological and immunological response to antiretroviral therapy in rural South African adults. PLoS ONE. 2011;6(7):e21795.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Nglazi MD, Kranzer K, Holele P, Kaplan R, Mark D, Jaspan H, et al. Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa. BMC Infect Dis. 2012;12:21.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Laher F, Hornschuh S, Otwombe K, Mohapi L, Violari A, Gray G. Outcomes of adolescents and young adults receiving antiretroviral therapy in Soweto, South Africa. 7th IAS Conference on HIV pathogenesis and treatment abstract no MOPE056. 2013. Kuala Lumpur.Google Scholar
  10. 10.
    Davies MA, Stinson K, Technau K, Phiri S, Rabie H, Wellington M, Giddy J, R, Mofenson L, Moultrie H, editor Outcomes of perinatally HIV-infected adolescents on antiretroviral therapy in Southern Africa. Conference on retrovirology and opportunistic infections (CROI) abstract no: 930. 2014. Boston.Google Scholar
  11. 11.
    Zanoni BC, Mayer KH. The adolescent and young adult HIV cascade of care in the United States: exaggerated health disparities. AIDS Patient Care STDS. 2014;28(3):128–35.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Davies MA, Tsondai P, Tiffin N, Eley B, Rabie H, Euvrard J, et al. Where do HIV-infected adolescents go after transfer?—tracking transition/transfer of HIV-infected adolescents using linkage of cohort data to a health information system platform. J Int AIDS Soc. 2017;20(Suppl 3):16–24.Google Scholar
  13. 13.
    Ryscavage P, Anderson EJ, Sutton SH, Reddy S, Taiwo B. Clinical outcomes of adolescents and young adults in adult HIV care. J Acquir Immune Defic Syndr. 2011;58(2):193–7.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Fish R, Judd A, Jungmann E, O’Leary C, Foster C. Mortality in perinatally HIV-infected young people in England following transition to adult care: an HIV young persons network (HYPNet) audit. HIV Med. 2014;15(4):239–44.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    World Health Organization. Making health services adolescent friendly: Developing national quality standards for adolescent-friendly health services. In: Department of Maternal N, Child and Adolescent Health, editor. Geneva: World Health Organization; 2012.Google Scholar
  16. 16.
    Teasdale CA, Alwar T, Chege D, Fayorsey R, Hawken MP, Abrams EJ. Impact of youth and adolescent friendly services on retention of 10–24-year-olds in HIV care and treatment programs in Nyanza, Kenya. J Acquir Immune Defic Syndr. 2016;71(2):e56–9.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Tanner AE, Philbin MM, Duval A, Ellen J, Kapogiannis B, Fortenberry JD, et al. “Youth friendly” clinics: considerations for linking and engaging HIV-infected adolescents into care. AIDS Care. 2014;26(2):199–205.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Pettitt ED, Greifinger RC, Phelps BR, Bowsky SJ. Improving health services for adolescents living with HIV in sub-Saharan Africa: a multi-country assessment. Afr J Reprod Health. 2013;17(4 Spec No):17–31.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Zanoni BC, Sibaya T, Cairns C, Lammert S, Haberer JE. Higher retention and viral suppression with adolescent-focused HIV clinic in South Africa. PLoS ONE. 2017;12(12):e0190260.CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Lee L, Yehia BR, Gaur AH, Rutstein R, Gebo K, Keruly JC, et al. The impact of youth-friendly structures of care on retention among HIV-infected youth. AIDS Patient Care STDS. 2016;30(4):170–7.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Murray KR, Dulli LS, Ridgeway K, Dal Santo L, de Mora DD, Olsen P, et al. Improving retention in HIV care among adolescents and adults in low- and middle-income countries a systematic review of the literature. PLoS ONE. 2017;12(9):e0184879.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Zuch M, Mason-Jones AJ, Mathews C, Henley L. Changes to the law on consent in South Africa: implications for school-based adolescent sexual and reproductive health research. BMC Int Health Hum Rights. 2012;12:3.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Strode A, Slack C, Essack Z. Child consent in South African law: implications for researchers, service providers and policy-makers. S Afr Med J. 2010;100(4):247–9.CrossRefPubMedGoogle Scholar
  24. 24.
    South African Marketing Research Association (SAMRA). Guideline for Research with Children in South Africa. In: Research M, editor. Johannesburg: SAMRA; 2015.Google Scholar
  25. 25.
    Cohen J, Reddington C, Jacobs D, Meade R, Picard D, Singleton K, et al. School-related issues among HIV-infected children. Pediatrics. 1997;100(1):E8.CrossRefPubMedGoogle Scholar
  26. 26.
    Anabwani G, Karugaba G, Gabaitiri L. Health, schooling, needs, perspectives and aspirations of HIV infected and affected children in Botswana: a cross-sectional survey. BMC Pediatr. 2016;16:106.CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Funck-Brentano I, Dalban C, Veber F, Quartier P, Hefez S, Costagliola D, et al. Evaluation of a peer support group therapy for HIV-infected adolescents. Aids. 2005;19(14):1501–8.CrossRefPubMedGoogle Scholar
  28. 28.
    Menon A, Glazebrook C, Campain N, Ngoma M. Mental health and disclosure of HIV status in Zambian adolescents with HIV infection: implications for peer-support programs. J Acquir Immune Defic Syndr. 2007;46(3):349–54.CrossRefPubMedGoogle Scholar
  29. 29.
    Nozyce ML, Lee SS, Wiznia A, Nachman S, Mofenson LM, Smith ME, et al. A behavioral and cognitive profile of clinically stable HIV-infected children. Pediatrics. 2006;117(3):763–70.CrossRefPubMedGoogle Scholar
  30. 30.
    Cohen HJ, Papola P, Alvarez M. Neurodevelopmental abnormalities in school-age children with HIV infection. J Sch Health. 1994;64(1):11–3.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Maughan-Brown B, Spaull N. HIV-related discrimination among grade six students in nine Southern African countries. PLoS ONE. 2014;9(8):e102981.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Midtbo V, Shirima V, Skovdal M, Daniel M. How disclosure and antiretroviral therapy help HIV-infected adolescents in sub-Saharan Africa cope with stigma. Afr J AIDS Res. 2012;11(3):261–71.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Dickson KE, Ashton J, Smith JM. Does setting adolescent-friendly standards improve the quality of care in clinics? Evidence from South Africa. Int J Qual Health Care. 2007;19(2):80–9.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Berg-Kelly K. Adolescent-friendly services. Acta Paediatr (Oslo, Norway: 1992). 2003;92(11):1241–2.CrossRefGoogle Scholar
  35. 35.
    Geng EH, Nash D, Kambugu A, Zhang Y, Braitstein P, Christopoulos KA, et al. Retention in care among HIV-infected patients in resource-limited settings: emerging insights and new directions. Curr HIV/AIDS Rep. 2010;7(4):234–44.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Thompson MA, Mugavero MJ, Amico KR, Cargill VA, Chang LW, Gross R, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817-33, W-284, W-5, W-6, W-7, W-8, W-9, W-90, W-91, W-92, W-93, W-94.Google Scholar

Copyright information

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

Authors and Affiliations

  1. 1.Massachusetts General HospitalBostonUSA
  2. 2.Harvard Medical SchoolBostonUSA
  3. 3.University of KwaZulu-Natal Nelson Mandela School of MedicineDurbanSouth Africa
  4. 4.Don McKenzie HospitalBotha’s HillSouth Africa

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