Disclosure, Social Support, and Mental Health are Modifiable Factors Affecting Engagement in Care of Perinatally-HIV Infected Adolescents: A Qualitative Dyadic Analysis

• Authors: Brian Zanoni, Emory University; Moherndran Archary, University of Kwazulu Natal; Tamarra Subramony, Mahatma Gandhi Hospital; Thobekile Sibaya, University of Kwazulu Natal; Christina Psaros, Massachusetts General Hospital; Jessica E Haberer, Massachusetts General Hospital
• Journal Title: AIDS AND BEHAVIOR
• Volume: Volume 25, Number 1
• Publisher: SPRINGER/PLENUM PUBLISHERS | 2020-07-07, Pages 237-248
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1007/s10461-020-02968-1
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: Science & Technology; Social Sciences; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Social Sciences, Biomedical; Biomedical Social Sciences; Adolescent; HIV; South Africa; Transition; Engagement in care; YOUNG-ADULTS; ACQUIRED HIV; TRANSITION; CHILDREN; RESILIENCE; OUTCOMES; MANAGEMENT; HIV/AIDS; SERVICES; THERAPY

Abstract

Adolescents living with perinatally acquired HIV in South Africa face significant barriers to successful transition from pediatric to adult care. We performed in-depth qualitative interviews with 41 adolescents living with HIV and 18 of their caregivers to investigate modifiable factors to improve engagement in care prior to transition to adult care. Based on dyadic, inductive content analysis, findings suggest that HIV status disclosure, social support, and mental health are targets for improvement in engagement in care. Early disclosure and a sense of belonging facilitated engagement in care, while barriers included delayed or inadequate disclosure, denial, and lack of disclosure to others. Adherence support improved by having a biological mother as a direct supervisor. Barriers to care included changing caregivers, abandonment, undiagnosed mental health problems and learning difficulties. Despite these factors, the majority of adolescents showed resilience and remained engaged in care despite difficult circumstances.