scholarly journals A Pilot Study of a Mobile Intervention to Support Mental Health and Adherence Among Adolescents Living with HIV in Western Kenya

2021 ◽  
Author(s):  
Ashley Chory ◽  
Grant Callen ◽  
Winstone Nyandiko ◽  
Tabitha Njoroge ◽  
Celestine Ashimosi ◽  
...  
Keyword(s):  
Pilot Study ◽  
Behavioral Health ◽  
Treatment Adherence ◽  
Peer Support ◽  
Mobile Technologies ◽  
Hiv Care ◽  
Individual Counseling ◽  
Middle Income ◽  
Western Kenya ◽  
Living With Hiv

AbstractMobile technologies represent potentially novel and scalable intervention delivery platforms for adolescents living with HIV (ALWH) in low- and middle-income countries. We conducted a prospective, mixed methods pilot study to evaluate the acceptability and feasibility of the WhatsApp® platform to deliver individual counseling services and facilitate peer support for ALWH in western Kenya. Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. After 6 months, participants described their experiences with the intervention. Treatment adherence, stigma, and mental and behavioral health were assessed prospectively. Participants reported overall positive experiences and indicated that the platform encouraged peer network development. They endorsed potential benefits for treatment adherence, stigma reduction, and mental and behavioral health. All participants supported intervention expansion. In western Kenya, WhatsApp® was an acceptable and feasible platform for mobile counseling and peer support for ALWH.

scholarly journals HIV-Related Knowledge, Attitudes, Behaviors and Experiences of Kenyan Adolescents Living with HIV Revealed in WhatsApp Group Chats

2021 ◽  
Vol 20 ◽  
pp. 232595822199957
Author(s):  
Ashley Chory ◽  
Winstone Nyandiko ◽  
Roxanne Martin ◽  
Josephine Aluoch ◽  
Michael Scanlon ◽  
...  
Keyword(s):  
Mental Health ◽  
School Setting ◽  
Mobile Technologies ◽  
Hiv Care ◽  
Hiv Knowledge ◽  
Middle Income ◽  
Middle Income Countries ◽  
Mental Health Support ◽  
Health Support ◽  
Living With Hiv

Introduction: Mobile technologies represent a scalable platform for delivering knowledge and interventions targeting adolescents living with HIV (ALWH) in low and middle income countries. Data from mobile interventions can be used to assess the contextual understanding and experiences of ALWH. Methods: We examined HIV-related knowledge, attitudes, beliefs, behaviors, and experiences of Kenyan ALWH revealed in the contextual data from enrollment in a WhatsApp® group chat intervention. Results: Thirty ALWH (17 female, mean age 15.4) on ART, engaged in HIV care and aware of their status, were enrolled. Qualitative analysis of WhatsApp® chat discussions identified a gap in HIV knowledge, high medication-taking literacy, need for mental health support and significant barriers to adherence. Participants discussed challenges with HIV stigma and medication-taking in the school setting. Conclusion: These discussions demonstrate a need for education on HIV topics, mental health support for ALWH, and interventions for stigma mitigation in the school setting.

Utility and acceptability of text messages for PMTCT: a qualitative assessment of user experiences (Preprint)

2021 ◽  
Author(s):  
Melinda Brown ◽  
May Maloba ◽  
Catherine Wexler ◽  
Natabhona Mabachi ◽  
Sharon Koech ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Pilot Study ◽  
Clinical Care ◽  
Text Messages ◽  
Hiv Care ◽  
Qualitative Assessment ◽  
Women Living With Hiv ◽  
Pregnancy And Postpartum ◽  
Living With Hiv ◽  
The Impact

BACKGROUND Evidence that text messages can support patient adherence to HIV care is growing. We conducted a pilot study of the HIV Infant Tracking System (HITSystem 2.0), an intervention that includes SMS to patients to support maternal medication adherence, appointment attendance, and hospital-based deliveries during the antenatal period. OBJECTIVE The objective of this study was to qualitatively assess women’s experiences receiving SMS to understand message utility and acceptability with the goal of refining and strengthening the intervention. METHODS As part of an intervention development pilot study, we conducted semi-structured interviews with 33 women living with HIV who received SMS through the HITSystem 2.0 throughout their pregnancy and postpartum period. Interview questions assessed women’s feedback of the SMS, the impact of the SMS on their PMTCT care, and suggestions for improvement. RESULTS Participants described how SMS reinforced existing strategies for medication adherence and served as cues to action for antenatal appointments and hospital-based deliveries. SMS also provided encouragement and enhanced their sense of engagement with their clinical care team. Given the neutral content of the messages, most women reported no concerns about message confidentiality. Recommendations to enhance utility included greater customizability (timing and frequency of messages) and a few women suggested more comprehensive counseling regarding the SMS content to anticipate at the time of enrollment. CONCLUSIONS SMS content was deemed useful and acceptable by pregnant and postpartum women living with HIV and engaged in PMTCT services. Participant recommendations to increase message customization options have been adopted to enhance the intervention. CLINICALTRIAL Trial registration: clinicaltrials.gov, NCT02726607. Registered 01 April 2016. Retrospectively registered. https://clinicaltrials.gov/ct2/show/NCT02726607

scholarly journals The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252623
Author(s):  
Rigmor C. Berg ◽  
Samantha Page ◽  
Anita Øgård-Repål
Keyword(s):  
Systematic Review ◽  
Peer Support ◽  
Evaluation System ◽  
Chronic Health Condition ◽  
Risk Of Bias ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Cd4 Cell Count ◽  
Living With Hiv

Background The practice of involving people living with HIV in the development and provision of healthcare has gained increasing traction. Peer-support for people living with HIV is assistance and encouragement by an individual considered equal, in taking an active role in self-management of their chronic health condition. The objective of this systematic review was to assess the effects of peer-support for people living with HIV. Methods We conducted a systematic review in accordance with international guidelines. Following systematic searches of eight databases until May 2020, two reviewers performed independent screening of studies according to preset inclusion criteria. We conducted risk of bias assessments and meta-analyses of the available evidence in randomised controlled trials (RCTs). The certainty of the evidence for each primary outcome was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation system. Results After screening 219 full texts we included 20 RCTs comprising 7605 participants at baseline from nine different countries. The studies generally had low risk of bias. Main outcomes with high certainty of evidence showed modest, but superior retention in care (Risk Ratio [RR] 1.07; Confidence Interval [CI] 95% 1.02–1.12 at 12 months follow-up), antiretroviral therapy (ART) adherence (RR 1.06; CI 95% 1.01–1.10 at 3 months follow-up), and viral suppression (Odds Ratio up to 6.24; CI 95% 1.28–30.5 at 6 months follow-up) for peer-support participants. The results showed that the current state of evidence for most other main outcomes (ART initiation, CD4 cell count, quality of life, mental health) was promising, but too uncertain for firm conclusions. Conclusions Overall, peer-support with routine medical care is superior to routine clinic follow-up in improving outcomes for people living with HIV. It is a feasible and effective approach for linking and retaining people living with HIV to HIV care, which can help shoulder existing services. Trial registration CRD42020173433.

scholarly journals A non-specialist depression care pathway for adolescents living with HIV and transitioning into adult care in Peru: a nested pilot study

2020 ◽  
Author(s):  
Jerome Galea ◽  
Carmen Contreras ◽  
Milagros Wong ◽  
Karen Ramos ◽  
Valentina Vargas ◽  
...  
Keyword(s):  
Mental Health ◽  
Pilot Study ◽  
Care Pathway ◽  
Hiv Care ◽  
Transition To Adult Care ◽  
Depression Symptom ◽  
Depression Care ◽  
Adult Care ◽  
Small Pilot Study ◽  
Living With Hiv

<p>Adolescents living with HIV (ALWH) are disproportionally impacted by depression and experience worse HIV outcomes compared to other age groups. Integrating depression care with HIV care for ALWH during transition to adult care—an especially crucial time when adolescents frequently disengage from HIV care—holds promise as a strategy for supporting antiretroviral adherence among ALWH, particularly in low- and middle-income countries where >90% of people with HIV live. </p> <p><br>In this brief article, we describe a small pilot study of a simple depression care pathway with psychological first aid delivered by non-mental health specialists for Peruvian ALWH transitioning to adult care. Though small, this is the first study to report on depression symptom prevalence among adolescents living with HIV in Peru and pilot test a depression care pathway that could inform future integration of mental health services with HIV care in Peru.</p>

scholarly journals The secret life of young adolescents living with HIV in northern Mozambique - a mixed methods study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Joana Falcão ◽  
Allison Zerbe ◽  
Claude Ann Mellins ◽  
Joanne Mantell ◽  
Kirsty Brittain ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Reproductive Health ◽  
Peer Support ◽  
Antiretroviral Treatment ◽  
Sexual And Reproductive Health ◽  
Hiv Care ◽  
Hiv Status ◽  
Care Needs ◽  
Caregiver Support ◽  
Living With Hiv

Abstract Background In Mozambique, HIV infection remains a leading cause of adolescent mortality. With advances in antiretroviral treatment (ART), the population of adolescents living with vertically-acquired HIV is growing. Most studies of adolescents living with HIV (ALHIV) focus on older youth with horizontal infection. As part of a larger study, we examined the characteristics and health care needs of younger ALHIV, including those with vertically-acquired infection to inform preventive interventions. Methods We used a convergent mixed-methods design and recruited ALHIV aged 12–14 years who were enrolled in HIV care in three health clinics in Nampula, Mozambique. From 11/2019–3/2020, we conducted 61 quantitative surveys and 14 in-depth interviews with a purposively selected subset of ALHIV who were aware of their HIV status. Descriptive statistical analysis was conducted for quantitative data. Qualitative data were transcribed and analyzed using thematic analysis. Results The median age of ALHIV was 13 years, 50% were female, 67% lived with ≥1 parent, 70% had lost a parent, 100% were in school; 10% were in a relationship, and 3% had initiated sexual activity. Among 31 ALHIV aware of their serostatus, the median age of antiretroviral treatment (ART) initiation was 8 years (IQR: 6–11); 55% received caregiver support for ART management; 35% reported missing ≥1 ART dose in the last 30 days; 6% had disclosed their HIV-status to friends and 48% reported no one to talk to about HIV-specific issues. Four main themes emerged from the qualitative interviews with ALHIV: a) learning one’s HIV-positive status as the beginning of a secret life; b) importance of caregivers’ support for ART management; c) high value of ALHIV peer support to overcome isolation, increase HIV literacy, and support adherence; and d) unmet needs for sexual and reproductive health education. Conclusion HIV-related secrecy prevails among ALHIV, a situation exacerbated by caregivers and healthcare providers. Caregivers play a major role in supporting adherence among young ALHIV, yet ALHIV could also benefit from adolescent-friendly services, including peer support, sexual and reproductive health services and preparation for independent health management. Integrating such programs into ART services in Mozambique may be critical to promoting ALHIV health.

scholarly journals “This is My Life We are Talking About”: Adaptive Strategies for HIV Care Retention and Treatment Adherence Among Postpartum Women Living with HIV in Cape Town, South Africa

2020 ◽  
Vol 24 (12) ◽  
pp. 1454-1463
Author(s):  
Alison Z. Weber ◽  
Jennifer A. Pellowski ◽  
Kirsty Brittain ◽  
Abigail Harrison ◽  
Tamsin K. Phillips ◽  
...  
Keyword(s):  
South Africa ◽  
Treatment Adherence ◽  
Cape Town ◽  
Adaptive Strategies ◽  
Hiv Care ◽  
Postpartum Women ◽  
Women Living With Hiv ◽  
Living With Hiv

scholarly journals Pregnancies among women living with HIV using contraceptives and antiretroviral therapy in western Kenya: a retrospective, cohort study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rena C. Patel ◽  
Gustavo Amorim ◽  
Beatrice Jakait ◽  
Bryan E. Shepherd ◽  
A. Rain Mocello ◽  
...  
Keyword(s):  
Cohort Study ◽  
Antiretroviral Therapy ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chart Review ◽  
Hiv Care ◽  
Western Kenya ◽  
Women Living With Hiv ◽  
Validation Sampling ◽  
Living With Hiv

Abstract Background Preventing unintended pregnancies is paramount for women living with HIV (WLHIV). Previous studies have suggested that efavirenz-containing antiretroviral therapy (ART) reduces contraceptive effectiveness of implants, but there are uncertainties regarding the quality of the electronic medical record (EMR) data used in these prior studies. Methods We conducted a retrospective, cohort study of EMR data from 2011 to 2015 among WLHIV of reproductive age accessing HIV care in public facilities in western Kenya. We validated a large subsample of records with manual chart review and telephone interviews. We estimated adjusted incidence rate ratios (aIRRs) with Poisson regression accounting for the validation sampling using inverse probability weighting and generalized raking. Results A total of 85,324 women contributed a total of 170,845 women-years (w-y) of observation time; a subset of 5080 women had their charts reviewed, and 1285 underwent interviews. Among implant users, the aIRR of pregnancy for efavirenz- vs. nevirapine-containing ART was 1.9 (95% CI 1.6, 2.4) using EMR data only and 3.2 (95% CI 1.8, 5.7) when additionally using both chart review and interview validated data. Among efavirenz users, the aIRR of pregnancy for depomedroxyprogesterone acetate (DMPA) vs. implant use was 1.8 (95% CI 1.5, 2.1) in EMR only and 2.4 (95% CI 1.0, 6.1) using validated data. Conclusion Pregnancy rates are higher when contraceptive implants are concomitantly used with efavirenz-containing ART, though rates were similar to leading alternative contraceptive methods such as DMPA. Our data provides policymakers, program staff, and WLHIV greater confidence in guiding their decision-making around contraceptive and ART options. Our novel, 3-phase validation sampling provides an innovative tool for using routine EMR data to improve the robustness of data quality.

scholarly journals Social, economic, and health effects of the COVID-19 pandemic on adolescents retained in or recently disengaged from HIV care in Kenya

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257210
Author(s):  
Leslie A. Enane ◽  
Edith Apondi ◽  
Josephine Aluoch ◽  
Giorgos Bakoyannis ◽  
Jayne Lewis Kulzer ◽  
...  
Keyword(s):  
Mental Health ◽  
Food Security ◽  
Social Economic ◽  
Healthcare Access ◽  
Study Groups ◽  
Hiv Care ◽  
Western Kenya ◽  
Need For Support ◽  
Wide Scale ◽  
Living With Hiv

Introduction Adolescents living with HIV (ALHIV, ages 10–19) experience complex challenges to adhere to antiretroviral therapy (ART) and remain in care, and may be vulnerable to wide-scale disruptions during the COVID-19 pandemic. We assessed for a range of effects of the pandemic on ALHIV in western Kenya, and whether effects were greater for ALHIV with recent histories of being lost to program (LTP). Methods ALHIV were recruited from an ongoing prospective study at 3 sites in western Kenya. The parent study enrolled participants from February 2019–September 2020, into groups of ALHIV either 1) retained in care or 2) LTP and traced in the community. Phone interviews from July 2020–January 2021 assessed effects of the pandemic on financial and food security, healthcare access and behaviors, and mental health. Responses were compared among the parent study groups. Results Phone surveys were completed with 334 ALHIV or their caregivers, including 275/308 (89.3%) in the retained group and 59/70 (84.3%) among those LTP at initial enrollment. During the pandemic, a greater proportion of LTP adolescents were no longer engaged in school (45.8% vs. 36.4%, p = 0.017). Over a third (120, 35.9%) of adolescents reported lost income for someone they relied on. In total, 135 (40.4%) did not have enough food either some (121, 36.2%) or most (14, 4.2%) of the time. More LTP adolescents (4/59, 6.8% vs. 2/275, 0.7%, p = 0.010) reported increased difficulties refilling ART. Adolescent PHQ-2 and GAD-2 scores were ≥3 for 5.6% and 5.2%, respectively. Conclusions The COVID-19 pandemic has had devastating socioeconomic effects for Kenyan ALHIV and their households. ALHIV with recent care disengagement may be especially vulnerable. Meanwhile, sustained ART access and adherence potentially signal resilience and strengths of ALHIV and their care programs. Findings from this survey indicate the critical need for support to ALHIV during this crisis.

scholarly journals Community-Based Accompaniment for Adolescents Transitioning to Adult HIV Care in Urban Peru: a Pilot Study

2021 ◽  
Author(s):  
Valentina Vargas ◽  
Milagros Wong ◽  
Carly A. Rodriguez ◽  
Hugo Sanchez ◽  
Jerome Galea ◽  
...  
Keyword(s):  
Social Support ◽  
Medication Adherence ◽  
Pilot Study ◽  
Health Workers ◽  
Transition Process ◽  
Hiv Care ◽  
Community Based ◽  
Transition Readiness ◽  
Sex With Men ◽  
Living With Hiv

AbstractIntroductionAdolescents living with HIV (ALWH) face an elevated risk of poor health outcomes when transitioning into adult-oriented care; however, evidence-based interventions to support ALWH during this high-risk period are lacking, especially in Latin America. We conducted a pilot study of a community-based intervention designed to improve outcomes among ALWH transitioning to adult HIV care in Lima, Peru.MethodsFrom October 2019 to January 2020, we enrolled adolescents transitioning to adult HIV care, either due to a recent diagnosis or having aged out of their pediatric clinic. ALWH previously lost from care during the transition process were also invited to participate. The nine-month intervention consisted of (1) logistical, adherence and social support delivered by entry-level health workers who accompanied adolescents during their transition to adult HIV care and (2) group sessions to improve health-related knowledge, skills and social support. We assessed intervention feasibility and effectiveness in improving medication adherence, psycho-social outcomes, and transition readiness after 6, 9, and 12 months.ResultsWe enrolled 30 ALWH, ages 15-21 years; 11 were recently diagnosed and 19 had been living with HIV since infancy or early childhood. Participants included ten men who have sex with men, four young pregnant women and six adolescents who were previously lost during the transition to adult HIV care. Intervention participation was high with 90% of ALWH attending at least one in-person social support session and all attending at least one live online session. No ALWH withdrew from the intervention, study, or antiretroviral therapy. In transition readiness, we observed within-person improvements related to personal health (+1.9 points, p<0.001), healthcare usage (+2.4 points, p<0.001), knowledge (+3.3 points, p=0.001), and behavior (+3 points, p=0.003) at the end of the intervention, relative to baseline. We also observed strong evidence of improvements in medication adherence, social support, self-efficacy, and perceived stress, which were generally sustained three months after intervention cessation.ConclusionWe identified a community-based intervention that is feasible and potentially effective for bridging the transition to adult HIV care among a diverse group of ALWH in Peru. A larger-scale effectiveness evaluation, including biological endpoints, is warranted.

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