Penn researchers interview HIV-positive adolescents in Botswana to better understand the factors affecting adherence to antiretroviral treatments

Of the more than three million children infected with HIV, 90% live in Africa. As HIV-positive children become adolescents, it is important that antiretroviral treatments are maintained to protect their own health, as well as to safeguard the adolescents from developing resistant strains of HIV and to prevent infection of other individuals.

HIV-positive adolescents’ adherence to these treatments has been identified as a public health challenge for Botswana. However, the assessment tools testing psychosocial factors that are likely associated with poor adherence have been developed in Western countries and their constructs may not be relevant to African contexts. A new study published in PLOS ONE by Penn researchers Elizabeth Lowenthal and Karen Glanz described the cultural adaptation of these assessment tools for Botswana.

The psychosocial assessments investigate factors that may affect adolescents’ adherence to antiretroviral treatments. As Lowenthal summarized, “one of the key reasons why adolescents with HIV have higher rates of death compared with people with HIV in other age groups is that they have trouble taking their medications regularly.”

Researchers looked at the following factors by testing 7 separate assessment scales developed with Western cohorts for their applicability to Botswanan adolescents.
  • Psychological reactance- an aversion to abide by regulations that impose upon freedom and autonomy
  • Perceived stigma
  • Outcome expectancy- whether treatments were expected to improve health
  • Consideration of future consequences- the extent to which adolescents plan for their futures rather than focusing on immediate gains
  • Socio-emotional support- how adolescents receive the social and emotional support they need

The researchers interviewed 34 HIV-positive Botswanan adolescents in depth, sub grouped by age in order to talk about the factors in ways participants could understand.

The study confirmed the construct validity of some assessment tools, but highlighted four areas that caused tools to not relate to participants:
  • Socio-emotional support for the adolescents mostly came from parents rather than peers.
  • Denial of being HIV infected was more common than expected.
  • Participants were surprisingly ambivalent about taking their medicine.

Some of the tools (psychological reactance, future consequences) required major modifications to obtain construct validity for adolescents with HVI in Botswana.The assessment tools were modified during the course of the study based on participant feedback. Future research will test the association between these modified assessment tools and HIV treatment outcomes in order to provide insight into how to best support HIV infected adolescents.

First author Lowenthal suggested that the study could inform studies of adolescent adherence to other treatments as well, stating that “questions that we are able to answer in our large cohort of HIV-positive adolescents will likely be generalizable to other groups of adolescents with chronic diseases.”

-Barbara McNutt 

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