Adolescents and HIV: kindness and time key factors for treatment retention

12 October 2018

New research from South Africa provides insights into the factors associated with retention of adolescents in HIV care, suggesting relatively low‐cost interventions could significantly improve adherence and retention in care.

young girls in South Africa with their arms around each other

Experiencing kindness from health staff, having someone to attend clinics with, and not being rushed in appointments are among a handful of factors strongly associated with adolescents in South Africa staying on HIV treatment.

The findings, published in the Journal of the International AIDS Society, are drawn from the experiences of just over 1,000 HIV-positive adolescents (aged 10 to 19) from a sub-district in the Eastern Cape where HIV prevalence among young people is high and healthcare faces resource challenges. 

Researchers identified all 10 to 19 year‐olds who had started antiretroviral treatment (ART) at a government-run facility in the area between March 2014 and September 2015. Combining health records with interviews and self-report data, they assessed the impact of 11 factors on the retention of adolescents in HIV care.

Of the 1,176 adolescents included in the study, 56% were considered fully retained in care – meaning that they had not missed any clinic visits in the past year and had fully adhered to treatment in the past week. 

84% reported not missing an appointment in the past year and 64% reported adhering to ART in the last week. 

Researchers controlled for age, gender, location, housing, orphan status, route of HIV infection, overall health, length of time on ART and type of healthcare facility.

Overall, five factors were found to be strongly associated with retention. Alongside staff kindness, being accompanied to clinics and having time in appointments, having enough money to get to clinics safely and clinics having HIV medication in stock were also significantly associated with better retention. 

When none of these factors were present, just 3.3% of adolescents reported retention, rising to between 4.7% and 9.2% if one of the five factors was present. With any two of the five factors present, retention ranged from 10.6% to 21.3%, with any three from 22.9% to 40.2%, and with any four from 44% to 61.5%. With all five, retention rose to 69.5%.

Surprisingly, the time it took to travel to a clinic, waiting times, access to sufficient information, trust in the confidentiality of health data, having a treatment ‘buddy’ or being a member of a monthly support group were not significantly associated with increased retention. However, as very few participants (14%) attended any support group, and only 5% attended an adolescent‐specific support group, the lack of an association with this final factor could indicate that those questioned were struggling to relate to the adult‐focused support services on offer.

These findings provide important insight into what matters to HIV-positive adolescents in South Africa when it comes to treatment. It suggests relatively low‐cost interventions within households and clinics could have a direct impact on retention rates.

Crucially, it indicates providing both financial and emotional support for adolescents living with HIV could be equally important for improving retention rates as strengthening health infrastructure and staff capacity. 

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Written by Hester Phillips