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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dc.contributor.authorCluver, L
dc.contributor.authorPantelic, M
dc.contributor.authorToska, E
dc.contributor.authorOrkin, M
dc.contributor.authorCasale, M
dc.contributor.authorBungane, N
dc.contributor.authorSherr, L
dc.date.accessioned2024-10-04T17:15:52Z
dc.date.available2024-10-04T17:15:52Z
dc.date.issued2018-09-21
dc.description.abstractIntroduction 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.
dc.identifier.citationCluver L, Pantelic M, Toska E, Orkin M, Casale M, Bungane N, Sherr L. 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. 2018;21(9):e25176. DOI: https://doi.org/10.1002/jia2.25176.
dc.identifier.urihttps://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25176
dc.identifier.urihttps://doi.org/10.1002/jia2.25176
dc.identifier.urihttps://hdl.handle.net/11288/597783
dc.language.isoen
dc.publisherWiley
dc.subjectHIV
dc.subjectadolescent
dc.subjectadolescent health services
dc.subjectdelivery of healthcare
dc.subjectmedication therapy management
dc.subjectviral load
dc.titleSTACKing the odds for adolescent survival: Health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa
dc.typeArticle
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