1. ADOLESCENT ART-ADHERENCE
CASH + CARE
+ HIV COMMUNITY?
SOCIAL PROTECTION AND
ADOLESCENT ART-ADHERENCE
Cluver, Toska, Orkin, Yakubovich, Hodes, Sherr & the Mzantsi Wakho Team

3. ART ADHERENCE: THE NEXT RISK
1.6 million HIV+ adolescents in Southern Africa (UNAIDS 2015)
7-60% adherence to ART (systematic review Hudelson 2015)
27-50% use of condoms (systematic review Toska 2016)
Morbidity, mortality, viral resistance, onwards HIV-infection
3 systematic reviews: virtually no effective interventions
(Hudelson 2015, MacPherson 2015, Vreeman 2008)
Testing associations of social protection with adherence in the world’s largest community sample of HIV+ adolescents

4. POLICY, RESEARCH AND TEENSLC

5. UNDERSTANDING NON-ADHERENCE
HIV+ ADOLESCENTS:
UNDERSTANDING NON-ADHERENCE
Quantitative longitudinal panel study ( )
N=1,526 adolescents, 1060 HIV+, 467 HIV-
Every adolescent who ever initiated ART
In an urban/rural health district of Eastern Cape: 53 health facilities
Community-tracing, 3-year longitudinal tracking
Clinical and interview data, standardised questionnaires LC
Qualitative research ( )
In-depth qualitative research with N=80 youth, healthcare workers,
social service providers, families and loved ones
Open-ended interviews, focus groups, home, school, clinic observations
(1000+hours)
Participatory exercises: dream clinics & consultations, youth summits

7. REPRESENTATIVITY & RELIABILITY (HIV+ n=1060) Eastern Cape, urban/rural/peri-urban, 53 government facilities
Self-reported past-week non-adherence – validity check
Detectable viral load
OR 1.98 CI
Opportunistic infections
OR 2.26, CI , p<.05
Independent of adolescent age, gender, perinatal/horizontal infection, rural/urban location, ethnicity, formal/informal home, maternal orphanhood, paternal orphanhood, general health status, time on treatment, travel time to clinic

8. WHO ARE OUR SAMPLE? (n=1526) LC

9. NON-ADHERENCE (n=1060 HIV+ adolescents)LC

10. FINDINGS INDEPENDENT OF:
SOCIO-ECONOMIC FACTORS: adolescent age, gender, language, formal/informal (shack) housing, urban/rural location, and education level (highest school grade passed)
ORPHANHOOD FACTORS: maternal, paternal, double
HIV AND MEDICATION FACTORS: perinatal/horizontal infection, caregiver who was AIDS-symptomatic/on ART, disclosure, duration of time on treatment
HEALTHCARE FACTORS: past-month self-reported health, time of travel to clinic, past-year hospitalisation.

11. % ACCESS TO SOCIAL PROTECTION

12. WHAT IMPACTS ADHERENCE?
OR .57, CI , p<.001
OR .60, CI , p<.02
OR .56, CI , p<.001

13. SOCIAL PROTECTION COMBINATIONS: LOWER NON-ADHERENCE
Cluver, Orkin, Toska, Hodes, Yakubovich, Sherr AIDS Care. 2016

14. WHERE ARE WE?
Non-adherence: immediate and urgent challenge
Social protection can improve adherence
Cash + care combinations: more effective
Scaling up access for HIV+ teens essential

15. WHERE ARE WE? Non-adherence: immediate and urgent challenge
Social protection improves adherence
Cash + care combinations: more effective
Scaling up access for HIV+ teens essential
Next research steps: pragmatic RCTs of combinations

16. INCREDIBLE TEAMS & TEENS
Analysis and writing: Lucie Cluver, Rebecca Hodes, Elona Toska, Lesley Gittings, Marija Pantelic, Mark Orkin, Lorraine Sherr, Mark Boyes, Franziska Meinck, Mosa Moshabela, Helen Nakatunda, Craig Carty.
Oxford team: Sarah Hoeksma, Colleen Kelly, Vince Evans Gutierrez, Melissa Pancoast, Amogh Sharma, Louis Pilard, Jenny Doubt, Alexa Yakubovich.
UCT team: Marius Coqui, Nondumiso Hlwele, Thobani Ncapai, Sarah Walters.
Fieldteam: W Booi, N Bungane, L Button, C Carty, KE Chademana, L Cluver, Y Dunkley, N Galela, C Gilmer, L Gittings, N Gwebecimele, R Haighighat, E He, A Heusel, R Hodes, M Isaacsohn, Z Jantjies, R Jopling, C Kama, B Kamile, B Kinana, V Luke, B Madondo, K Makabane, B Makwenkwe, T Mampangashe, Z Marikeni, D Mark, X Matebese, A Mayekiso, A Mbiko, A Mboyiya, D Mhlauli, S Medley, F Meinck, P Mngese, S Mngese, P Mjo, S Mona, T Moyikwa, S Mpimpilashe, M Mpumlwana, S Mqalo, S Mwellie, P Myoyo, M Neel, U Ngesi, S Ngozi, P Nobatye, N Nurova, M Pantelic, L Parmley, L Pilard, T Ramncwana, A Robb, J Rosenfeld, B Saliwe, J Sandelson, L Sidloyi, I Skracic, R Smith, N Sontsonga, J Steinert, B Taleni, M Thabeng, E Toska, S Tshaka, T Tsiba, B Vale, T Walker, P Wardle.
Research assistants: N Bhambra, N Bobrowitz, K Kidia, A Naik, A Redfern. LG