eprintid: 10092336
rev_number: 17
eprint_status: archive
userid: 608
dir: disk0/10/09/23/36
datestamp: 2020-02-25 19:44:35
lastmod: 2021-12-10 23:40:09
status_changed: 2020-02-25 19:44:35
type: article
metadata_visibility: show
creators_name: Sherr, L
creators_name: Cluver, LD
creators_name: Toska, E
creators_name: He, E
title: Differing psychological vulnerabilities among behaviourally and perinatally HIV infected adolescents in South Africa - implications for targeted health service provision
ispublished: pub
divisions: UCL
divisions: B02
divisions: D01
divisions: G16
keywords: Behavioural transmission, vertical transmission, sexual transmission, perinatal transmission, HIV-positive adolescents, mental health, treatment, South Africa
note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
abstract: HIV infections are growing the fastest amongst adolescents, especially in sub Saharan Africa. On reaching adolescence, perinatally-infected youth may have different needs to those who acquired infection behaviourally. Yet both have sub-optimal adherence with implications for their own health as well as onward transmission. This study uses the world's largest community-based study of HIV-positive adolescents from the Eastern Cape, South Africa. Clinic records at N = 53 district health facilities generated a log of all ART-initiated adolescents who were then interviewed in the community: N = 1058 (90%) were tracked and participated. Ethical approval, informed consent and data collector training preceded data gathering. Inventories comprised validated measures of mental health (depression, anxiety, suicidality and internalised stigma), substance use, ART adherence, and clinic attendance. Analyses were conducted using SPSS25 and STATA15. Perinatally-infected adolescents (n = 792, 77.3%) were significantly more likely to be ART adherent (OR = 1.54 95%CI: 1.14–2.07 p = 0.005), retained in healthcare (OR = 1.59 95%CI1.18–2.14 p = 0.002), and treated well by clinic staff (OR = 2.12 95%CI1.59–3.07 p ≤ 0.001). Behaviourally-infected adolescents were more likely to be depressed (B = 0.81 p ≤ 0.001), anxious (B = 1.36 p ≤ 0.001), report internalised stigma (B = 0.91 p ≤ 0.001), express suicidal ideation (OR = 3.65 95%CI: 1.96–6.82 p ≤ 0.001) and report excessive substance use in the past year (OR = 9.37 95%CI5.73–15.35 p ≤ 0.001). Being older explained most of these differences, with female adolescents living with HIV more likely to report suicidal ideation. However, behaviourally-infected adolescents were more likely to report substance use (OR = 2.69 95%CI: 1.48–4.91 p = 0.001), depression (B = 0.406, p = 0.022), anxiety (B = 1.359, p ≤ 0.001), and internalised stigma (B = 0.403, p = 0.007) in multivariate regression analyses, controlling for covariates. Moderation analyses (adjusting for multiple testing) suggest that behaviourally-infected HIV-positive adolescents who are also maternal orphans are more likely to report higher rates of depression (B = 1.075, p < 0.001). These notable differences by mode of infection suggest that studies which conflate HIV-positive adolescents may blur the clinical and psychological experiences of these two different sub-populations. Drivers of non-adherence, poor retention in care, and mental health problems may differ by mode of infection, requiring tailored interventions. Health and social service provision, if it is to be effective, needs to address these different youth profiles to ensure optimal adherence, development and wellbeing throughout the life course.
date: 2018-05-30
date_type: published
publisher: ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD
official_url: http://doi.org/10.1080/09540121.2018.1476664
oa_status: green
full_text_type: other
language: eng
primo: open
primo_central: open_green
verified: verified_manual
elements_id: 1561897
doi: 10.1080/09540121.2018.1476664
lyricists_name: Sherr, Lorraine
lyricists_id: LSHER47
actors_name: Waragoda Vitharana, Nimal
actors_id: NWARR44
actors_role: owner
full_text_status: public
publication: AIDS Care  Psychological and Socio-medical Aspects of AIDS/HIV
volume: 30
pagerange: 92-101
pages: 10
issn: 1360-0451
citation:        Sherr, L;    Cluver, LD;    Toska, E;    He, E;      (2018)    Differing psychological vulnerabilities among behaviourally and perinatally HIV infected adolescents in South Africa - implications for targeted health service provision.                   AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV , 30    pp. 92-101.    10.1080/09540121.2018.1476664 <https://doi.org/10.1080/09540121.2018.1476664>.       Green open access   
 
document_url: https://discovery-pp.ucl.ac.uk/id/eprint/10092336/1/Sherr_modeofinfectionsubmitted%20%281%29.pdf