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BMC Health Services Research
Published in: BMC Health Services Research 1/2018

Open Access 01-12-2018 | Research article

Characteristics of adolescents living with HIV receiving care and treatment services in antiretroviral therapy clinics in Cambodia: descriptive findings from a cross-sectional study

Authors: Siyan Yi, Sovannary Tuot, Khuondyla Pal, Vohith Khol, Say Sok, Pheak Chhoun, Laura Ferguson, Gitau Mburu

Published in: BMC Health Services Research | Issue 1/2018

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Abstract

Background

Adolescents living with HIV experience worse HIV care outcomes compared to adults, especially during transition from pediatric to adult care. However, data regarding adolescents are limited. This paper describes and compares characteristics of male and female adolescents living with HIV preparing for transition from pediatric to adult care in Cambodia.

Methods

This cross-sectional study was conducted in August 2016 among 328 adolescents aged 15–17, randomly selected from 11 antiretroviral therapy (ART) clinics. Data were collected using a structured questionnaire, and descriptive analyses were conducted to compare characteristics of male and female adolescents.

Results

Of total, 55.2% were male, and 40.8% were living with parents. Majority (82.6%) got HIV infection from their mothers. Overall, adolescents had received ART for an average of 8.4 years, and HIV care for 9.5 years. Additionally, 82.4% were on first line ART regimen. Mean CD4 count from the most recent test was 672 cells/mm3, and viral load was 7686 copies/mL. Overall, 95.6% were adherent to ART on Visual Analogue Scale. About half (50.7%) had never disclosed their HIV status to anyone, while the remaining had disclosed it to their siblings (24.2%), friends (13.0%), schoolteachers (2.4%), or other (5.8%). A fifth reported having had boy or girlfriends, but few (2.1%) had ever had sexual intercourse. Females were more likely to have been engaged in sexual intercourse, and none reported having used a condom in their last intercourse. Few participants reported having ever used tobacco (1.8%), or any kind of illicit drugs (0.9%), but almost a fifth (20.7%) had a history of alcohol use. The majority (82.1%) were aware that they were receiving ART. HIV-related knowledge was suboptimal among the sample.

Conclusions

This study provides a snapshot of immunological, virological, adherence, and disclosure outcomes that should be tracked during and following healthcare transition to evaluate the effectiveness of the transition program. Findings showed high ART adherence, low likelihood of disclosure outside of family circles, sub-optimal condom use, and poor knowledge of HIV. To provide individualized support for healthcare transition, pediatric and adult clinics need to ensure that these characteristics are taken into account.
Literature
1.
UNAIDS. joint United Nations Programme on HIV/AIDS. Global report: UNAIDS report on the global AIDS epidemic. Geneva: UNAIDS; 2012.
2.
Ferrand RA, Corbett EL, Wood R, Hargrove J, Ndhlovu CE, Cowan FM, et al. AIDS among older children and adolescents in southern Africa: projecting the time course and magnitude of the epidemic. AIDS. 2009;23(15):2039–46.CrossRef
3.
Mun M, Sopheab H, Tuot S, Morgan P, Pal K, Chhoun P, et al. National HIV Sentinel Survey among Women Attending Antenatal Care Clinics in Cambodia in 2014. Phnom Penh: National Center for HIV/AIDS, Dermatology and STD (NCHADS); 2016.
4.
National Center for HIV/AIDS Dermatology and STD (NCHADS). Diagnosis and treatment for HIV infected infant, children and adolescents in Cambodia. Phnom Penh: NCHADS; 2013.
5.
UNAIDS joint United Nations Programme on HIV/AIDS. Gap report. Geneva: UNAIDS; 2015.
6.
Idele P, Gillespie A, Porth T, Suzuki C, Mahy M, Kasedde S, et al. Epidemiology of HIV and AIDS among adolescents: current status, inequities, and data gaps. J Acquir Immune Defic Syndr. 2014;66(Suppl 2):S144–53.CrossRef
7.
Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, et al. Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa. J Acquir Immune Defic Syndr. 2009;51(1):65–71.CrossRef
8.
Merzel C, VanDevanter N, Irvine M. Adherence to antiretroviral therapy among older children and adolescents with HIV: a qualitative study of psychosocial contexts. AIDS Patient Care STD. 2008;22(12):977–87.CrossRef
9.
Ramirez-Avila L, Nixon K, Noubary F, Giddy J, Losina E, Walensky RP, et al. Routine HIV testing in adolescents and young adults presenting to an outpatient clinic in Durban, South Africa. PLoS One. 2012;7(9):e45507.CrossRef
10.
Mburu G, Ram M, Oxenham D, Haamujompa C, Iorpenda K, Ferguson L. Responding to adolescents living with HIV in Zambia: a social–ecological approach. Child Youth Serv Rev. 2014:459–17.
11.
Siu GE, Bakeera-Kitaka S, Kennedy CE, Dhabangi A, Kambugu A. HIV serostatus disclosure and lived experiences of adolescents at the transition Clinic of the Infectious Diseases Clinic in Kampala, Uganda: a qualitative study. AIDS Care. 2012;24(5):606–11.CrossRef
12.
Mburu G, Hodgson I, Kalibala S, Haamujompa C, Cataldo F, Lowenthal ED, et al. Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes. J Int AIDS Soc. 2014;17:18866.CrossRef
13.
Fair C, Albright J. "Don't tell him you have HIV unless he's 'the one'": romantic relationships among adolescents and young adults with perinatal HIV infection. AIDS Patient Care STD. 2012;26(12):746–54.CrossRef
14.
Lall P, Lim SH, Khairuddin N, Kamarulzaman A. An urgent need for research on factors impacting adherence to and retention in care among HIV-positive youth and adolescents from key populations. J Int AIDS Soc. 2015;18(2):19393.PubMedPubMedCentral
15.
Busza J, Strode A, Dauya E, Ferrand RA. Falling through the gaps: how should HIV programmes respond to families that persistently deny treatment to children? J Int AIDS Soc. 2016;19(1):20789.CrossRef
16.
Binagwaho A, Fuller A, Kerry V, Dougherty S, Agbonyitor M, Wagner C, et al. Adolescents and the right to health: eliminating age-related barriers to HIV/AIDS services in Rwanda. AIDS Care. 2012;24(7):936–42.CrossRef
17.
Lee S, Hazra R. Achieving 90-90-90 in paediatric HIV: adolescence as the touchstone for transition success. J Int AIDS Soc. 2015;18(Suppl 6):20257.PubMedPubMedCentral
18.
Wiener LS, Kohrt BA, Battles HB, Pao M. The HIV experience: youth identified barriers for transitioning from pediatric to adult care. J Pediatr Psychol. 2011;36(2):141–54.CrossRef
19.
Boudreau ME, Fisher CM. Providing effective medical and case management services to HIV-infected youth preparing to transition to adult care. J Assoc Nurses AIDS Care. 2012;23(4):318–28.CrossRef
20.
Miles K, Edwards S, Clapson M. Transition from paediatric to adult services: experiences of HIV-positive adolescents. AIDS Care. 2004;16(3):305–14.CrossRef
21.
Maturo D, Powell A, Major-Wilson H, Sanchez K, De Santis JP, Friedman LB. Development of a protocol for transitioning adolescents with HIV infection to adult care. J Ped Health Care. 2011;25(1):16–23.CrossRef
22.
Maturo D, Powell A, Major-Wilson H, Sanchez K, De Santis JP, Friedman LB. Transitioning adolescents and young adults with HIV infection to adult care: pilot testing the "Movin' out" transitioning protocol. J Pediatr Nurs. 2015;30(5):e29–35.CrossRef
23.
Sharma N, Willen E, Garcia A, Sharma TS. Attitudes toward transitioning in youth with perinatally acquired HIV and their family caregivers. J Assoc Nurses AIDS Care. 2014;25(2):168–75.CrossRef
24.
Straub DM, Tanner AE. Health-care transition from adolescent to adult services for young people with HIV. Lancet Child Adolesc Health. 2018;2(3):214–22.CrossRef
25.
Wiener L, Battles H, Ryder C, Zobel M. Transition from a pediatric HIV intramural clinical research program to adolescent and adult community-based care services: assessing transition readiness. Soc Work Health Care. 2007;46(1):1–9.CrossRef
26.
World Health Organization (WHO). HIV and Adolescents. Guidance for HIV testing and counseling and Care for Adolescents Living with HIV: recommendations for a public health approach and considerations for policy-makers and managers. Geneva: WHO; 2013.
27.
Porth T, Suzuki C, Gillespie A, Kasedde S, Idele P. Disparities and trends in AIDS mortality among teenagers living with HIV in low–and middle-income countries. Melbourne: 20th international AIDS conference; 2014.
28.
Baggaley R, Armstrong A, Dodd Z. Young key populations and HIV: a special emphasis and consideration in the new WHO consolidated guidelines on HIV prevention, diagnosis, treatment and Care for key Populations. J Int AIDS Soc. 2015;18(2):19438.PubMedPubMedCentral
29.
Islam MS, Minichiello V, Scott J. Children living in HIV families: a review. J Child Adolesc Behav. 2015;2(5):1–7.
30.
Shroufi A, Gunguwo H, Dixon M, Nyathi M, Ndebele W, Saint-Sauveur JF, et al. HIV-infected adolescents in southern Africa can achieve good treatment outcomes: results from a retrospective cohort study. AIDS. 2013;27(12):1971–8.CrossRef
31.
National Center for HIV/AIDS Dermatology and STD (NCHADS). Factors affecting the Transition from Paediatric to Adult HIV Care Services among Children Living with HIV Aged 12–17 in Cambodia. Phnom Penh: NCHADS; 2012.
32.
Seng SDT, Welle E, Mok S, Soch K, Tep S, et al. Stigma and discrimination as factors affecting the transition from Paediatric to adult HIV care services by children living with HIV aged 12–17 in Cambodia: a qualitative exploratory study. Melbourne: International AIDS Conference; 2014.
33.
Chandler C, Ngoksin A. Lost in transitions: current issues faced by adolescents living with HIV in Asia Pacific. UNICEF: Bangkok; 2013.
34.
Toth G, Mburu G, Tuot S, Khol V, Ngin C, Chhoun P, et al. Social-support needs among adolescents living with HIV in transition from pediatric to adult care in Cambodia: findings from a cross-sectional study. AIDS Res Ther. 2018;15(1):8.CrossRef
35.
Yi S, Ngin C, Pal K, Khol V, Tuot S, Sau S, et al. Transition into adult care: factors associated with level of preparedness among adolescents living with HIV in Cambodia. AIDS Res Ther. 2017;14(1):33.CrossRef
36.
Skinner J. Probability proportional to size (PPS) sampling. London: Wiley; 2006.CrossRef
37.
Henderson RH, Sundaresan T. Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method. Bull World Health Organ. 1982;60(2):253–60.PubMedPubMedCentral
38.
Bakeera-Kitaka S, Nabukeera-Barungi N, Nostlinger C, Addy K, Colebunders R. Sexual risk reduction needs of adolescents living with HIV in a clinical care setting. AIDS Care. 2008;20(4):426–33.CrossRef
39.
Amico KR, Fisher WA, Cornman DH, Shuper PA, Redding CG, Konkle-Parker DJ, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42(4):455–9.CrossRef
40.
World Medical Association (WMA). Declaration of Helsinki: ethical principles for medical research involving human subjects. (2008 revision). Seoul: world medical association; 2008.
41.
Save the Children. So you want to involve children in research? Stockholm: save the children; 2004.
42.
White AJ, Howland L, Clark MJ. Enhancing acquisition of health care management skills in youth living with HIV prior to transition: a pilot study. J Assoc Nurses AIDS Care. 2015;26(3):296–300.CrossRef
43.
Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007;19(1):28–33.CrossRef
44.
Martinez J, Harper G, Carleton RA, Hosek S, Bojan K, Clum G, et al. The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care STD. 2012;26(2):108–15.CrossRef
45.
Abubakar A, Van de Vijver FJ, Fischer R, Hassan AS, Gona JK, Dzombo JT, et al. 'Everyone has a secret they keep close to their hearts': challenges faced by adolescents living with HIV infection at the Kenyan coast. BMC Public Health. 2016;16:197.CrossRef
46.
Dowshen N, D'Angelo L. Health care transition for youth living with HIV/AIDS. Pediatrics. 2011;128(4):762–71.CrossRef
47.
Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014;28(13):1945–56.CrossRef
48.
Valenzuela JM, Buchanan CL, Radcliffe J, Ambrose C, Hawkins LA, Tanney M, Rudy BJ. Transition to adult services among behaviorally infected adolescents with HIV—a qualitative study. J Ped Psych. 2009;36(2):134–40.CrossRef
49.
Ryscavage P, Macharia T, Patel D, Palmeiro R, Tepper V. Linkage to and retention in care following healthcare transition from pediatric to adult HIV care. AIDS Care. 2016;28(5):561–5.CrossRef
50.
Kakkar F, Van der Linden D, Valois S, Maurice F, Onnorouille M, Lapointe N, et al. Health outcomes and the transition experience of HIV-infected adolescents after transfer to adult care in Quebec, Canada. BMC Pediatr. 2016;16:109.CrossRef
51.
Righetti A, Prinapori R, Nulvesu L, Fornoni L, Viscoli C, Di Biagio A. Transitioning HIV-infected children and adolescents into adult care: an Italian real-life experience. J Assoc Nurses AIDS Care. 2015;26(5):652–9.CrossRef
52.
Hodgson I, Ross J, Haamujompa C, Gitau-Mburu D. Living as an adolescent with HIV in Zambia -- lived experiences, sexual health and reproductive needs. AIDS Care. 2012;24(10):1204–10.CrossRef
53.
Kenu E, Obo-Akwa A, Nuamah GB, Brefo A, Sam M, Lartey M. Knowledge and disclosure of HIV status among adolescents and young adults attending an adolescent HIV clinic in Accra, Ghana. BMC Res Notes. 2014;7:844.CrossRef
54.
Thoth CA, Tucker C, Leahy M, Stewart SM. Self-disclosure of serostatus by youth who are HIV-positive: a review. J Behav Med. 2014;37(2):276–88.CrossRef
55.
Hogwood J, Campbell T, Butler S. I wish I could tell you but I can't: adolescents with perinatally acquired HIV and their dilemmas around self-disclosure. Clin Child Psychol Psychiatry. 2013;18(1):44–60.CrossRef
56.
Fernet M, Wong K, Richard ME, Otis J, Levy JJ, Lapointe N, et al. Romantic relationships and sexual activities of the first generation of youth living with HIV since birth. AIDS Care. 2011;23(4):393–400.CrossRef
57.
Friedman HL. Changing patterns of adolescent sexual behavior: consequences for health and development. J Adolesc Health. 1992;13(5):345–50.CrossRef
58.
Lowenthal ED, Bakeera-Kitaka S, Marukutira T, Chapman J, Goldrath K, Ferrand RA. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges. Lancet Infect Dis. 2014;14(7):627–39.CrossRef
59.
Bygrave H, Mtangirwa J, Ncube K, Ford N, Kranzer K, Munyaradzi D. Antiretroviral therapy outcomes among adolescents and youth in rural Zimbabwe. PLoS One. 2012;7(12):e52856.CrossRef
60.
Machado DM, Succi RC, Turato ER. Transitioning adolescents living with HIV/AIDS to adult-oriented health care: an emerging challenge. J Pediatr. 2010;86(6):465–72.
61.
Tanner AE, Philbin MM, DuVal A, Ellen J, Kapogiannis B, Fortenberry JD. Transitioning HIV-positive adolescents to adult care: lessons learned from twelve adolescent medicine clinics. J Pediatr Nurs. 2016;31(5):537–43.CrossRef
62.
Valenzuela JM, Buchanan CL, Radcliffe J, Ambrose C, Hawkins LA, Tanney M, et al. Transition to adult services among behaviorally infected adolescents with HIV--a qualitative study. J Pediatr Psychol. 2011;36(2):134–40.CrossRef
63.
Christie CD, Pierre RB. Eliminating vertically-transmitted HIV/AIDS while improving access to treatment and care for women, children and adolescents in Jamaica. West Indian Med J. 2012;61(4):396–404.CrossRef
64.
Philbin MM, Tanner AE, Chambers BD, Ma A, Ware S, Lee S, et al. Transitioning HIV-infected adolescents to adult care at 14 clinics across the United States: using adolescent and adult providers' insights to create multi-level solutions to address transition barriers. AIDS Care. 2017;29(10):1227–34.CrossRef
65.
Rackal JM, Tynan AM, Handford CD, Rzeznikiewiz D, Agha A, Glazier R. Provider training and experience for people living with HIV/AIDS. Cochrane Database Syst Rev. 2011;15(6):Cd003938.
66.
Sangsari S, Milloy MJ, Ibrahim A, Kerr T, Zhang R, Montaner J, et al. Physician experience and rates of plasma HIV-1 RNA suppression among illicit drug users: an observational study. BMC Infect Dis. 2012;12:22.CrossRef
Metadata
Title
Characteristics of adolescents living with HIV receiving care and treatment services in antiretroviral therapy clinics in Cambodia: descriptive findings from a cross-sectional study
Authors
Siyan Yi
Sovannary Tuot
Khuondyla Pal
Vohith Khol
Say Sok
Pheak Chhoun
Laura Ferguson
Gitau Mburu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-018-3580-1

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