STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Wiley Open Access
Abstract
INTRODUCTION: There are two million HIV-positive adolescents in southern Africa, and this group has low retention in care and
high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self-reported retention.
This study examines factors associated with retention amongst antiretroviral therapy (ART)-initiated adolescents in South
Africa.
METHODS: We collected clinical records and detailed standardized interviews (n = 1059) with all 10- to 19 year-olds ever initiated
on ART in all 53 government clinics of a health subdistrict, and community traced to include lost-to-follow-up (90.1% of
eligible adolescents interviewed). Associations between full self-reported retention in care (no past-year missed appointments
and 85% past-week adherence) and health service factors were tested simultaneously in sequential multivariate regression and
marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal
and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility.
RESULTS: About 56% of adolescents had self-reported retention in care, validated against lower detectable viral load
(AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors (STACK) were associated with improved
retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents (OR: 2.7, CI: 1.8 to 4.1);
adolescents Accompanied to the clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4, CI: 1.1 to 1.9);
and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all
five factors, 69.5% reported retention.
CONCLUSIONS: This study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and
community services has the potential to STACK the odds for health and survival for HIV-positive adolescents.
Description
Keywords
Adolescent, HIV, Delivery of healthcare, Medication therapy management, Adolescent health services, Viral load
Citation
Cluver, L. et al. (2018). STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa. Journal of the International AIDS Society, 21: e25176