Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.

<h4>Introduction</h4>Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), a...

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Autores principales:	Philippe R Mutwa, Jennifer Ilo Van Nuil, Brenda Asiimwe-Kateera, Evelyne Kestelyn, Joseph Vyankandondera, Robert Pool, John Ruhirimbura, Chantal Kanakuze, Peter Reiss, Sibyl Geelen, Janneke van de Wijgert, Kimberly R Boer
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/6ba00d9fcd804adb9a6f8185c8e77437
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spelling	oai:doaj.org-article:6ba00d9fcd804adb9a6f8185c8e774372021-11-18T07:50:46ZLiving situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.1932-620310.1371/journal.pone.0060073https://doaj.org/article/6ba00d9fcd804adb9a6f8185c8e774372013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23573232/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4>Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), and in-depth interviews (IDI)) to better understand adherence barriers for Rwandan adolescents. Forty-two HIV positive adolescents (ages 12-21) and a selection of their primary caregivers were interviewed. All were perinatally-infected and received (cART) for ≥ 12 months. Topics discussed during FGDs and IDIs included learning HIV status, disclosure and stigma, care and treatment issues, cART adherence barriers.<h4>Results</h4>Median age was 17 years, 45% female, 45% orphaned, and 48% in boarding schools. We identified three overarching but inter-related themes that appeared to influence adherence. Stigma, perceived and experienced, and inadvertent disclosure of HIV status hampered adolescents from obtaining and taking their drugs, attending clinic visits, carrying their cARTs with them in public. The second major theme was the need for better support, in particular for adolescents with different living situations, (orphanages, foster-care, and boarding schools). Lack of privacy to keep and take medication came out as major barrier for adolescents living in congested households, as well the institutionalization of boarding schools where privacy is almost non-existent. The third important theme was the desire to be 'normal' and not be recognized as an HIV-infected individual, and to have a normal life not perturbed by taking a regimen of medications or being forced to disclose where others would treat them differently.<h4>Conclusions</h4>We propose better management of HIV-infected adolescents integrated into boarding school, orphanages, and foster care; training of school-faculty on how to support students and allow them privacy for taking their medications. To provide better care and support, HIV programs should stimulate caregivers of HIV-infected adolescents to join them for their clinic visits.Philippe R MutwaJennifer Ilo Van NuilBrenda Asiimwe-KateeraEvelyne KestelynJoseph VyankandonderaRobert PoolJohn RuhirimburaChantal KanakuzePeter ReissSibyl GeelenJanneke van de WijgertKimberly R BoerPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 4, p e60073 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Philippe R Mutwa Jennifer Ilo Van Nuil Brenda Asiimwe-Kateera Evelyne Kestelyn Joseph Vyankandondera Robert Pool John Ruhirimbura Chantal Kanakuze Peter Reiss Sibyl Geelen Janneke van de Wijgert Kimberly R Boer Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.
description	<h4>Introduction</h4>Adherence to combination antiretroviral therapy (cART) is vital for HIV-infected adolescents for survival and quality of life. However, this age group faces many challenges to remain adherent. We used multiple data sources (role-play, focus group discussions (FGD), and in-depth interviews (IDI)) to better understand adherence barriers for Rwandan adolescents. Forty-two HIV positive adolescents (ages 12-21) and a selection of their primary caregivers were interviewed. All were perinatally-infected and received (cART) for ≥ 12 months. Topics discussed during FGDs and IDIs included learning HIV status, disclosure and stigma, care and treatment issues, cART adherence barriers.<h4>Results</h4>Median age was 17 years, 45% female, 45% orphaned, and 48% in boarding schools. We identified three overarching but inter-related themes that appeared to influence adherence. Stigma, perceived and experienced, and inadvertent disclosure of HIV status hampered adolescents from obtaining and taking their drugs, attending clinic visits, carrying their cARTs with them in public. The second major theme was the need for better support, in particular for adolescents with different living situations, (orphanages, foster-care, and boarding schools). Lack of privacy to keep and take medication came out as major barrier for adolescents living in congested households, as well the institutionalization of boarding schools where privacy is almost non-existent. The third important theme was the desire to be 'normal' and not be recognized as an HIV-infected individual, and to have a normal life not perturbed by taking a regimen of medications or being forced to disclose where others would treat them differently.<h4>Conclusions</h4>We propose better management of HIV-infected adolescents integrated into boarding school, orphanages, and foster care; training of school-faculty on how to support students and allow them privacy for taking their medications. To provide better care and support, HIV programs should stimulate caregivers of HIV-infected adolescents to join them for their clinic visits.
format	article
author	Philippe R Mutwa Jennifer Ilo Van Nuil Brenda Asiimwe-Kateera Evelyne Kestelyn Joseph Vyankandondera Robert Pool John Ruhirimbura Chantal Kanakuze Peter Reiss Sibyl Geelen Janneke van de Wijgert Kimberly R Boer
author_facet	Philippe R Mutwa Jennifer Ilo Van Nuil Brenda Asiimwe-Kateera Evelyne Kestelyn Joseph Vyankandondera Robert Pool John Ruhirimbura Chantal Kanakuze Peter Reiss Sibyl Geelen Janneke van de Wijgert Kimberly R Boer
author_sort	Philippe R Mutwa
title	Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.
title_short	Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.
title_full	Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.
title_fullStr	Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.
title_full_unstemmed	Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.
title_sort	living situation affects adherence to combination antiretroviral therapy in hiv-infected adolescents in rwanda: a qualitative study.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/6ba00d9fcd804adb9a6f8185c8e77437
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Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study.

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