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