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Mental health and functional competence in the Cape Town adolescent antiretroviral cohort

Hoare, J
Phillips, N
Brittain, K
Myer, L
Zar, H.J
Stein, D.J
Background: The impact of HIV and antiretrovirals (ART) on long-term mental health in perinatally infected children has not been well studied in sub-Saharan Africa where HIV is most prevalent. Setting: Cape Town, South Africa. Methods: We investigated mental health measures, including depression, anxiety, attention-deficit hyperactivity disorder, motivation, disruptive behavior, and functioning in perinatally infected adolescents (PHIV+) stable on ART within the Cape Town Adolescent Antiretroviral Cohort. Two hundred four adolescents living with HIV (median age 10 years; mean CD4 953) and a sample of 44 uninfected adolescents were enrolled. The Beck Youth Inventories, Children's Motivation Scale, Conner's Parent's Rating Scale, and Child Behavior Checklist were administered. Among PHIV+, we explored independent associations between HIV-related stigma, recent life stressors, sociodemographic, clinical, and caregiver-related variables, and mental health measures. Results: PHIV+ had poorer functional competence, self-concept and motivation, higher levels of disruptive behavior, depression and attention-deficit hyperactivity disorder symptoms and clinically significant anger and disruptive behavior. Within the PHIV+ group, the loss of both biological parents was associated with higher levels of disruptive behavior. Within the PHIV+, factors associated with mental health symptoms and poorer functioning were mostly sociodemographic factors, HIV-related stigma, and life stressors. Age of initiation of ART was associated with self-concept, and failing first-line ART with internalizing and externalizing behavior problems. Conclusions: PHIV+ are likely to face future physical and psychological health consequences related to the functional competence challenges they face if mental health care is not made a priority in the fight against HIV.
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Wolters Kluwer
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Mental health,HIV,Antiretrovirals (ART),Adolescent,sub-Saharan Africa
Hoare J, Phillips N, Brittain K, Myer L, Zar HJ, Stein DJ. Mental health and functional competence in the Cape Town adolescent antiretroviral cohort. J Acquir Immune Defic Syndr. 2019 Aug 1;81(4):e109-e116. doi: 10.1097/QAI.0000000000002068.
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