Cluver, L;
Meinck, F;
Toska, E;
Orkin, FM;
Hodes, R;
Sherr, L;
(2018)
Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa.
AIDS
, 32
(8)
pp. 975-983.
10.1097/QAD.0000000000001795.
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Abstract
Objectives: 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 victimization by caregivers, teachers, peers, community members, and healthcare providers. Design and methods: HIV-positive adolescents were interviewed (n¼1060), and clinic biomarker data collected.Wesampled all 10–19-year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between nonadherence and nine violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects. Results: Past-week self-reported ART nonadherence was 36%. Nonadherence 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 nonadherence: 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 victimization by healthcare staff (OR 2.15, CI 1.59–2.93). Past-week nonadherence rose from 25% with no violence to 73.5% with four types of violence exposure. Conclusion: Violence exposures at home, school, and clinic are major and cumulating risks for adolescent antiretroviral nonadherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.
| Type: | Article |
|---|---|
| Title: | Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1097/QAD.0000000000001795 |
| Publisher version: | https://doi.org/10.1097/QAD.0000000000001795 |
| Language: | English |
| Additional information: | This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
| Keywords: | Science & Technology, Life Sciences & Biomedicine, Immunology, Infectious Diseases, Virology, adherence, adolescence, child abuse, HIV/AIDS, violence, INTIMATE PARTNER VIOLENCE, ADVERSE CHILDHOOD EXPERIENCES, RANDOMIZED CONTROLLED-TRIAL, MIDDLE-INCOME COUNTRIES, SEXUAL RISK BEHAVIOR, SELF-REPORT MEASURES, MEDICATION ADHERENCE, HIV-INFECTION, IMMUNOLOGICAL OUTCOMES, PERINATAL HIV |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute for Global Health > Infection and Population Health |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10051642 |
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