Peer-reviewed article
Multitype violence exposures and adolescent antiretroviral nonadherence in South Africa
Lucie Dale Cluver, Franziska Meinck, Elona Toska, Frederick Mark Orkin, Rebecca Hodes et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how different types of violence affect whether HIV-positive adolescents in South Africa take their antiretroviral medicines as prescribed. Researchers interviewed over 1,000 young people aged 10-19 living with HIV across 53 clinics and found that 36% reported not taking their medication in the past week. Violence from caregivers, teachers, and healthcare staff, as well as witnessing domestic violence, were each independently linked to medication non-adherence. The risk increased dramatically when young people experienced multiple types of violence, rising from 25% non-adherence with no violence exposure to 73.5% with four types of violence.
Key points
- 36% of HIV-positive adolescents reported past-week antiretroviral non-adherence
- Four violence types were independently associated with non-adherence: physical abuse by caregivers (OR 1.5), witnessing domestic violence (OR 1.8), teacher violence (OR 1.51), and verbal victimization by healthcare staff (OR 2.15)
- Non-adherence was strongly correlated with virologic failure (OR 2.3) and symptomatic pulmonary tuberculosis (OR 1.49)
- Past-week non-adherence increased from 25% with no violence exposure to 73.5% with four types of violence exposure
- Violence exposures at home, school, and clinic are cumulative risks for medication non-adherence
Limitations
The study is cross-sectional and cannot establish causality between violence exposure and non-adherence. Self-reported adherence and violence measures may be subject to recall and social desirability bias.
Abstract
OBJECTIVES: HIV-positive adolescents have low-ART adherence, with consequent increased risks of mortality, morbidity, and viral resistance. Despite high rates of violence against children in the Africa region, no known studies have tested impacts on HIV-positive adolescents. We examine associations of ART adherence with adolescent violence victimization by caregivers, teachers, peers, community members, and healthcare providers. DESIGN AND METHODS: HIV-positive adolescents were interviewed (n = 1060), and clinic biomarker data collected. We sampled all 10-19-year olds ever ART-initiated within 53 clinics in 180 South African communities (90.1% reached). Analyses examined associations between nonadherence and nine violence types using sequential multivariate logistic regressions. Interactive and additive effects were tested with regression and marginal effects. RESULTS: Past-week self-reported ART nonadherence was 36%. Nonadherence correlated strongly with virologic failure (OR 2.3, CI 1.4-3.8) and symptomatic pulmonary tuberculosis (OR 1.49, CI 1.18-2.05). Four violence types were independently associated with nonadherence: physical abuse by caregivers (OR 1.5, CI 1.1-2.1); witnessing domestic violence (OR 1.8, CI 1.22-2.66); teacher violence (OR 1.51, CI 1.16-1.96,) and verbal victimization by healthcare staff (OR 2.15, CI 1.59-2.93). Past-week nonadherence rose from 25% with no violence to 73.5% with four types of violence exposure. CONCLUSION: Violence exposures at home, school, and clinic are major and cumulating risks for adolescent antiretroviral nonadherence. Prevention, mitigation, and protection services may be essential for the health and survival of HIV-positive adolescents.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- This is an observational study examining associations between violence exposures and ART adherence; no intervention was tested
- Population
- HIV-positive adolescents aged 10-19 years ever initiated on ART (n=1060) across 53 clinics in 180 South African communities
Key finding
36% past-week self-reported ART non-adherence overall