Project Details

Research Cluster: CEBI
Start Date: 01.02.2014
End Date: 31.01.2017

Pathways to survival: identifying psychosocial, family and service mechanisms to improve anti-retroviral adherence amongst HIV-positive adoescents in Southern Africa

DSPI Principal Investigator: Professor Lucie Cluver
Funded by: Nuffield Foundation

1.2 million adolescents in Southern Africa are living with HIV (UNICEF, 2012). Antiretroviral medication provides an opportunity for survival and long-term wellbeing, but requires adherence of 80-95%, without which the virus develops resistance to the medication (Paterson, 2000). Poor adherence can lead to illness and death, and as adolescents become sexually active they can pass on drug-resistant HIV. The very limited research shows exceptionally low rates of around 20% of adolescents maintaining adherence (Nachega, 2009). Lifetime daily adherence is strongly influenced by psychological, social and family context. But the very limited research on adolescent antiretroviral adherence is almost exclusively biomedical, and in high-income countries.

This proposed study is a direct collaboration with UNICEF, UNAIDS and Departments of the South African Government, with sub-Saharan African NGOs. It addresses a major social science research gap by identifying risk and resilience-promoting pathways (Rutter, 2005) for adherence amongst adolescents in Southern Africa. The study tracks adolescents through the health system over two years, using rigorous virologic and other measures of adherence, with a theoretical framework of interlinking risk and resilience-promoting factors for adherence, including mental health, family and cultural factors, romantic relationships and health services experiences.

A multidisciplinary approach is necessary to understand this complex phenomenon, and this study will combine longitudinal quantitative and qualitative methods with 575 adolescents, recruiting from health facilities and including both clinic attendees and defaulters. Findings will contribute to understandings of adolescent development and resilience in the context of a multifaceted and stigmatised disease. Furthermore, impact will be ensured by active policy and capacity-building collaboration, engagement with health services, NGOs, international HIV funders, and the South African government. By identifying potentially modifiable intervening factors for improving adolescent adherence, and by effectively disseminating these findings, this study will inform evidence-based interventions for an expanding and highly vulnerable group.

Related Publications

  • Hudelson, C & Cluver, L (2015) "Factors associated with adherence to antiretroviral therapy among adolescents living in low- and middle income countries: a systematic review ", AIDS Care 27: 7 805-16. doi: 10.1080/09540121.2015.1011073

  • Cluver, L,Orkin, M, Meinck, F, Boyes, M and Sherr, L (2016) "Structural drivers and social protection: Mechanisms of HIV-risk and HIV-prevention for South African adolescents", Journal of the International AIDS Society 19 2064-6