Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?
Low ART-adherence amongst adolescents is associated with morbidity, mortality and onwards HIV-transmission. Reviews find no effective adherence-promoting interventions for adolescents. Social protection (cash + care) has shown benefits in other adolescent HIV-outcomes such as prevention, and has pot...
| Main Authors: | , , , , , , |
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| Format: | Journal article |
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Taylor and Francis (Routledge)
2016
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| _version_ | 1797078418916900864 |
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| author | Cluver, L Toska, E Orkin, M Meinck, F Hodes, R Yakubovich, A Sherr, L |
| author_facet | Cluver, L Toska, E Orkin, M Meinck, F Hodes, R Yakubovich, A Sherr, L |
| author_sort | Cluver, L |
| collection | OXFORD |
| description | Low ART-adherence amongst adolescents is associated with morbidity, mortality and onwards HIV-transmission. Reviews find no effective adherence-promoting interventions for adolescents. Social protection (cash + care) has shown benefits in other adolescent HIV-outcomes such as prevention, and has potential to support ART-adherence. This study examines associations of ten potential social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10-19 year olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa’s Eastern Cape were traced and interviewed in 2014-15 (n=1175 eligible). 90.1% of the eligible sample was included (n=1059). Potential social protection predictors were ‘cash/cash in kind’: government cash transfers, food security, school fees/materials, school feeding, clothing; and ‘care’: HIV support group, sports groups, choir/art groups, positive parenting and high parental supervision/monitoring. Analyses used multivariate regression, checks for interaction and calculation of marginal effects models in SPSS and STATA. Analyses controlled for sociodemographic, HIV and healthcare-related covariates. Findings showed that self-reported past-week ART non-adherence (<95%) was 36%, and past-year non-adherence 52%. Past-week non-adherence was associated with increased opportunistic infections in the past 6 months (p=.005, B.269 SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1-3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR.57, CI.42-.76, p<.001); attending an HIV support group (aOR.60, CI.40-.91, p<.02), and high parental/caregiver supervision (aOR.56, CI.43-.73, p<.001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection it was 39-41%, with any two social protections, 27-28%, and with all three social protections, 18%. These results demonstrate that social protection provisions including food, parenting support and HIV support groups may improve adolescent adherence. Combinations of ‘cash plus care’ social protections have potential to improve survival and wellbeing, help to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents. |
| first_indexed | 2024-03-07T00:31:40Z |
| format | Journal article |
| id | oxford-uuid:8001e6d4-9ade-4b36-8d36-00485984c6d8 |
| institution | University of Oxford |
| last_indexed | 2024-03-07T00:31:40Z |
| publishDate | 2016 |
| publisher | Taylor and Francis (Routledge) |
| record_format | dspace |
| spelling | oxford-uuid:8001e6d4-9ade-4b36-8d36-00485984c6d82022-03-26T21:20:35ZAchieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:8001e6d4-9ade-4b36-8d36-00485984c6d8Symplectic Elements at OxfordTaylor and Francis (Routledge)2016Cluver, LToska, EOrkin, MMeinck, FHodes, RYakubovich, ASherr, LLow ART-adherence amongst adolescents is associated with morbidity, mortality and onwards HIV-transmission. Reviews find no effective adherence-promoting interventions for adolescents. Social protection (cash + care) has shown benefits in other adolescent HIV-outcomes such as prevention, and has potential to support ART-adherence. This study examines associations of ten potential social protection provisions with adherence in a large community-based sample of HIV-positive adolescents. All 10-19 year olds ever ART-initiated in 53 government healthcare facilities in a health district of South Africa’s Eastern Cape were traced and interviewed in 2014-15 (n=1175 eligible). 90.1% of the eligible sample was included (n=1059). Potential social protection predictors were ‘cash/cash in kind’: government cash transfers, food security, school fees/materials, school feeding, clothing; and ‘care’: HIV support group, sports groups, choir/art groups, positive parenting and high parental supervision/monitoring. Analyses used multivariate regression, checks for interaction and calculation of marginal effects models in SPSS and STATA. Analyses controlled for sociodemographic, HIV and healthcare-related covariates. Findings showed that self-reported past-week ART non-adherence (<95%) was 36%, and past-year non-adherence 52%. Past-week non-adherence was associated with increased opportunistic infections in the past 6 months (p=.005, B.269 SD .09), and increased likelihood of detectable viral load at last test (>75 copies/ml) (aOR 1.98, CI 1.1-3.45). Independent of covariates, three social protection provisions were associated with reduced non-adherence: food provision (aOR.57, CI.42-.76, p<.001); attending an HIV support group (aOR.60, CI.40-.91, p<.02), and high parental/caregiver supervision (aOR.56, CI.43-.73, p<.001). Combination social protection showed additive benefits. With no social protection, non-adherence was 54%, with any one protection it was 39-41%, with any two social protections, 27-28%, and with all three social protections, 18%. These results demonstrate that social protection provisions including food, parenting support and HIV support groups may improve adolescent adherence. Combinations of ‘cash plus care’ social protections have potential to improve survival and wellbeing, help to prevent HIV transmission, and to advance treatment equity for HIV-positive adolescents. |
| spellingShingle | Cluver, L Toska, E Orkin, M Meinck, F Hodes, R Yakubovich, A Sherr, L Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? |
| title | Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? |
| title_full | Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? |
| title_fullStr | Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? |
| title_full_unstemmed | Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? |
| title_short | Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa? |
| title_sort | achieving equity in hiv treatment outcomes can social protection improve adolescent art adherence in south africa |
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