Understanding patterns of family support and its role on viral load suppression among youth living with HIV aged 15 to 24 years in southwestern Uganda

Health Science Reports, Volume 5, No. 1, Year 2022

Ukuhunyushwa

Background: Active family support helps as a buffer against adverse life events associated with antiretroviral therapy (ART) uptake and adherence. There is limited data available to explain how family support shapes and affects individual healthcare choices, decisions, experiences, and health outcomes among youth living with HIV (YLWH). We aimed to describe family support patterns and its role in viral load suppression among YLWH at a rural hospital in southwestern Uganda. Methods: We performed a mixed-method cross-sectional study between March and September 2020, enrolling 88 eligible YLWH that received ART for at least 6 months. Our primary outcome of interest was viral load suppression, defined as a viral load detected of ≤500 copies/mL. Data analysis was performed using Statistical Package for Social Sciences version 20. Fifteen individuals were also purposively selected from the original sample and participated in an in-depth interview that was digitally recorded. Generated transcripts were coded and categories generated manually using the inductive content analytic approach. All participants provided written consent or guardian/parent assent (those <18 years) to participate in the study. Results: Forty-nine percent of YLWH were females, the median age was 21 (IQR: 16-22) years. About half of the participants (53%) stayed with a family member. A third (34%) of participants had not disclosed their status to any person they stayed with at home. Only 23% reported getting moderate to high family social support (Median score 2.3; IQR: 1.6-3.2). Seventy-eight percent of YLWH recorded viral load suppression. Viral load suppression was associated with one living with a parent, sibling, or spouse (AOR: 6.45; 95% CI: 1.16-16.13; P =.033), having a primary caretaker with a regular income (AOR: 1.57; 95% CI: 1.09-4.17; P =.014), and living or communicating with family at least twice a week (AOR: 4.2; 95% CI: 1.65-7.14; P =.003). Other significant factors included youth receiving moderate to high family support (AOR: 12.11; 95% CI: 2.06-17.09; P =.006) and those that perceived family support in the last 2 years as helpful (AOR: 1.98; 95% CI: 1.34-3.44; P =.001). HIV stigma (AOR: 0.10; 95% CI: 0.02-0.23; P =.007) and depression (AOR: 0.31; 95% CI: 0.06-0.52; P =.041) decreased viral load suppression. Qualitative data showed that dysfunctional family relationships, economic insecurity, physical separation, HIV- and disclosure-related stigma, past and ongoing family experiences with HIV/ART affected active family support. These factors fueled feelings of abandonment, helplessness, discrimination, and economic or emotional strife among YLWH. Conclusion: Our data showed that living with a family member, having a primary caretaker with a regular income, living or communicating with family members regularly, and reporting good family support were associated with viral load suppression among YLWH in rural southwestern Uganda. Experiencing depression due to HIV and or disclosure-related stigma was associated with increased viral load. All YLWH desire ongoing emotional, physical, and financial support from immediate family to thrive and take medications daily and timely. Future interventions should explore contextual community approaches that encourage acceptance, disclosure, and resource mobilization for YLWH who rely on family support to use ART appropriately. We conducted a cross‐sectional study to describe the patterns of family support and its effect on viral load suppression among youth aged 15 to 24 years in southwestern Uganda. The study was conducted at the Kinoni Health Center IV, a publically funded and operated health center in Rwampara, a rural, resource‐limited district located in southwestern Uganda. The health center serves over 100 000 patients annually from across 20 villages. It provides general outpatient care, maternal and child health care, inpatient care, general surgery, laboratory diagnostics, and HIV care services to both children and adults. The study was conducted among YLWH between 15 and 24 years of age, both male and female, registered at the ART clinic of Kinoni Health Centre IV. We selected all study participants who had attended the HIV/ART clinic for the last 6 months as per the facility records assisted by the nurse‐in‐charge for the required age group. We enrolled youth between 15 and 24 years of age, both male and female, living with HIV and registered at Kinoni Health Centre IV for HIV/ART care. Eligible participants should have been enrolled on ART for at least 6 months. We excluded individuals who declined to give consent, those who did not have viral load records in their files, and those who were unable to complete the informed consent or assent process as assessed by the study research assistants (RAs). Trained RAs approached eligible participants on the phone if available or notified the clinic front desk to be contacted if an eligible participant turned up for review. RAs introduced the study to the eligible participant and/or the guardian or parent if they came together at the clinic. The RA then obtained voluntary written informed consent from all eligible participants in the local language within a private area of the hospital. Those who could not write made their thumbprint on the consent form. The RAs obtained permission from a guardian or parent who came with participants below 18 years of age to the health facility. A total of 88 YLWH completed study procedures. A subset of 15 YLWH was purposively selected from the total enrolled individuals for qualitative interviews based on study participant's family relationship dynamics, viral load outcome, ART enrolment duration, experience, HIV disclosure status, social support characteristics, and variations in the types and quality of social support provided by family members. In addition, participants were invited to come to the clinic or private research space alone. The interviews aimed at gathering in‐depth information from specific participants with characteristics that would help explain their experiences and the role of family support on their ART uptake and utilization. Participants completed a structured interviewer‐led questionnaire with data on known explanatory factors that affect ART uptake and adherence: socio‐demographics, health and depression, 16 HIV sero‐status disclosure, food insecurity, 11 alcohol use, 17 HIV stigma, 18 and social support. 19 The questionnaire also contained sections on the last viral load recorded over the previous 6 months, relationship and communication with members at home, income, disclosure status, presence of an HIV‐positive family member, the number of people at home, and family support. Our primary outcome of interest was viral load suppression, defined as a viral load of less than or equal to 500 copies/mL. We expressed the quality of family support as emotional (psychological and informational) and instrumental (physical and economic) social support obtained from family members using a standardized score ranging from 1 to 4, 19 with 4 indicating high levels of social support. An in‐depth interview was administered to 15 purposively selected YLWH, which explored family and primary caretaker relationships, ART and disclosure experiences, pill‐taking behavior, food insecurity, and type and variations of family support. The interview guide was developed using the Health Utilization Model (HUM). 20 All qualitative interviews were conducted within 1 week of participant enrolment by two trained RAs and were digitally recorded with the participant's permission in the native local language (Runyankole) in a comfortable and private location within the Health Center premises or a mutually agreed personal space. Interviews lasted between 45 minutes to 1 hour. The recorded interviews were transcribed from the local language directly to English by a well‐trained RA. We considered all the 88 YLWH who completed all study procedures. We described demographic and clinical data for the enrolled participants using standard descriptive statistics. We assessed participant correlates of poor viral load suppression of viral load ≤500 copies/mL, computed for each participant. All data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20. We estimated the P values with Chi‐squared tests utilizing a level of statistical significance of ≤.05. Continuous variables were summarized using medians and interquartile ranges. We used univariate logistic regression to assess unadjusted associations between covariates and viral load suppression, and these were expressed using crude odds ratio (OR) and 95% confidence intervals (CIs). We tested the variables for collinearity. Those with a P value of less than or equal to .10 in unadjusted analyses were included in a multivariable logistic regression analysis, adding one at a time to control for confounders. Interviews were transcribed in English and coded manually. Coding was jointly done by ECA and RN. Together with others, disagreements in coding were resolved to ensure consistency. We reviewed the coded data to identify repeated patterns and sorted them to derive categories using the inductive content analytic approach. 21 We aimed to construct categories describing individual healthcare experiences, relationship dynamics, involvement and perspectives of family to support healthcare decisions, ART uptake and utilization, as well as barriers and challenges that affect their well‐being. Themes were then generated from the categories identified and presented with illustrative quotes from the participants' interviews to explain how these relationships and support—or lack thereof—shape their healthcare decisions and access to and utilization of ART care. This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (MUREC1/7) and the Uganda National Council of Science and Technology (RESCLEAR/01). In addition, the team obtained approvals from the District Health Officer of Rwampara District and the facility in‐charge of Kinoni Health Centre IV before conducting the research.

I-AI Digest

Study Justification:

– Active family support is important for youth living with HIV (YLWH) in managing their healthcare choices and outcomes.
– Limited data exists on how family support affects YLWH in Uganda.
– This study aimed to understand family support patterns and its role in viral load suppression among YLWH in southwestern Uganda.

Study Highlights:

– The study enrolled 88 YLWH aged 15 to 24 years who had been on antiretroviral therapy (ART) for at least 6 months.
– Results showed that living with a family member, having a primary caretaker with a regular income, and regular communication with family members were associated with viral load suppression.
– Good family support and perceiving family support as helpful were also associated with viral load suppression.
– Factors such as dysfunctional family relationships, economic insecurity, HIV-related stigma, and past experiences with HIV/ART affected family support and influenced viral load suppression.
– Depression and HIV-related stigma decreased viral load suppression.

Recommendations for Lay Reader:

– Youth living with HIV should strive to live with family members who can provide support.
– Having a primary caretaker with a regular income can positively impact viral load suppression.
– Regular communication with family members is important for viral load suppression.
– Youth should seek and maintain good family support to improve their health outcomes.
– Addressing depression and HIV-related stigma is crucial for viral load suppression.

Recommendations for Policy Maker:

– Develop interventions that promote acceptance, disclosure, and resource mobilization for YLWH who rely on family support for ART adherence.
– Implement programs to address dysfunctional family relationships, economic insecurity, and HIV-related stigma among YLWH.
– Provide support services for YLWH to address depression and mental health challenges.
– Strengthen healthcare systems to ensure regular communication and engagement with family members of YLWH.
– Allocate resources for training healthcare providers on the importance of family support in HIV care.

Key Role Players:

– Healthcare providers: Responsible for providing comprehensive care and support to YLWH, including promoting family support.
– Community leaders: Engage in community mobilization and sensitization efforts to reduce HIV-related stigma and promote acceptance of YLWH.
– NGOs and support groups: Provide psychosocial support, counseling, and economic empowerment programs for YLWH and their families.
– Policy makers: Develop and implement policies that support family-centered care for YLWH.
– Researchers: Conduct further studies to explore the impact of family support on health outcomes among YLWH.

Cost Items for Planning Recommendations:

– Training programs for healthcare providers on family-centered care: Includes costs for curriculum development, training materials, and facilitators.
– Community mobilization and sensitization campaigns: Includes costs for organizing community meetings, printing materials, and hiring facilitators.
– Psychosocial support services: Includes costs for hiring counselors, providing counseling sessions, and support group activities.
– Economic empowerment programs: Includes costs for vocational training, startup capital, and monitoring and evaluation.
– Policy development and implementation: Includes costs for policy drafting, stakeholder consultations, and monitoring and evaluation.
– Research funding: Includes costs for study design, data collection, analysis, and dissemination.

Amandla Obufakazi

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it provides detailed information about the study design, methods, and results. The study used a mixed-method cross-sectional design and included both quantitative and qualitative data. The sample size was adequate, and statistical analysis was performed using appropriate methods. The results showed significant associations between family support and viral load suppression among youth living with HIV. The qualitative data provided additional insights into the role of family support in ART uptake and utilization. To improve the evidence, the abstract could include more information about the limitations of the study, such as potential biases or confounding factors. Additionally, it would be helpful to provide recommendations for future research or interventions based on the findings.

Abstract

We conducted a cross‐sectional study to describe the patterns of family support and its effect on viral load suppression among youth aged 15 to 24 years in southwestern Uganda. The study was conducted at the Kinoni Health Center IV, a publically funded and operated health center in Rwampara, a rural, resource‐limited district located in southwestern Uganda. The health center serves over 100 000 patients annually from across 20 villages. It provides general outpatient care, maternal and child health care, inpatient care, general surgery, laboratory diagnostics, and HIV care services to both children and adults. The study was conducted among YLWH between 15 and 24 years of age, both male and female, registered at the ART clinic of Kinoni Health Centre IV. We selected all study participants who had attended the HIV/ART clinic for the last 6 months as per the facility records assisted by the nurse‐in‐charge for the required age group. We enrolled youth between 15 and 24 years of age, both male and female, living with HIV and registered at Kinoni Health Centre IV for HIV/ART care. Eligible participants should have been enrolled on ART for at least 6 months. We excluded individuals who declined to give consent, those who did not have viral load records in their files, and those who were unable to complete the informed consent or assent process as assessed by the study research assistants (RAs). Trained RAs approached eligible participants on the phone if available or notified the clinic front desk to be contacted if an eligible participant turned up for review. RAs introduced the study to the eligible participant and/or the guardian or parent if they came together at the clinic. The RA then obtained voluntary written informed consent from all eligible participants in the local language within a private area of the hospital. Those who could not write made their thumbprint on the consent form. The RAs obtained permission from a guardian or parent who came with participants below 18 years of age to the health facility. A total of 88 YLWH completed study procedures. A subset of 15 YLWH was purposively selected from the total enrolled individuals for qualitative interviews based on study participant's family relationship dynamics, viral load outcome, ART enrolment duration, experience, HIV disclosure status, social support characteristics, and variations in the types and quality of social support provided by family members. In addition, participants were invited to come to the clinic or private research space alone. The interviews aimed at gathering in‐depth information from specific participants with characteristics that would help explain their experiences and the role of family support on their ART uptake and utilization. Participants completed a structured interviewer‐led questionnaire with data on known explanatory factors that affect ART uptake and adherence: socio‐demographics, health and depression, 16 HIV sero‐status disclosure, food insecurity, 11 alcohol use, 17 HIV stigma, 18 and social support. 19 The questionnaire also contained sections on the last viral load recorded over the previous 6 months, relationship and communication with members at home, income, disclosure status, presence of an HIV‐positive family member, the number of people at home, and family support. Our primary outcome of interest was viral load suppression, defined as a viral load of less than or equal to 500 copies/mL. We expressed the quality of family support as emotional (psychological and informational) and instrumental (physical and economic) social support obtained from family members using a standardized score ranging from 1 to 4, 19 with 4 indicating high levels of social support. An in‐depth interview was administered to 15 purposively selected YLWH, which explored family and primary caretaker relationships, ART and disclosure experiences, pill‐taking behavior, food insecurity, and type and variations of family support. The interview guide was developed using the Health Utilization Model (HUM). 20 All qualitative interviews were conducted within 1 week of participant enrolment by two trained RAs and were digitally recorded with the participant's permission in the native local language (Runyankole) in a comfortable and private location within the Health Center premises or a mutually agreed personal space. Interviews lasted between 45 minutes to 1 hour. The recorded interviews were transcribed from the local language directly to English by a well‐trained RA. We considered all the 88 YLWH who completed all study procedures. We described demographic and clinical data for the enrolled participants using standard descriptive statistics. We assessed participant correlates of poor viral load suppression of viral load ≤500 copies/mL, computed for each participant. All data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20. We estimated the P values with Chi‐squared tests utilizing a level of statistical significance of ≤.05. Continuous variables were summarized using medians and interquartile ranges. We used univariate logistic regression to assess unadjusted associations between covariates and viral load suppression, and these were expressed using crude odds ratio (OR) and 95% confidence intervals (CIs). We tested the variables for collinearity. Those with a P value of less than or equal to .10 in unadjusted analyses were included in a multivariable logistic regression analysis, adding one at a time to control for confounders. Interviews were transcribed in English and coded manually. Coding was jointly done by ECA and RN. Together with others, disagreements in coding were resolved to ensure consistency. We reviewed the coded data to identify repeated patterns and sorted them to derive categories using the inductive content analytic approach. 21 We aimed to construct categories describing individual healthcare experiences, relationship dynamics, involvement and perspectives of family to support healthcare decisions, ART uptake and utilization, as well as barriers and challenges that affect their well‐being. Themes were then generated from the categories identified and presented with illustrative quotes from the participants' interviews to explain how these relationships and support—or lack thereof—shape their healthcare decisions and access to and utilization of ART care. This study was approved by the Mbarara University of Science and Technology Research Ethics Committee (MUREC1/7) and the Uganda National Council of Science and Technology (RESCLEAR/01). In addition, the team obtained approvals from the District Health Officer of Rwampara District and the facility in‐charge of Kinoni Health Centre IV before conducting the research.

Izinto zokwakha

N/A

Emisha

Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and support to pregnant women, such as reminders for prenatal appointments, educational resources, and access to healthcare providers via telemedicine.

2. Community Health Workers: Train and deploy community health workers to provide education, counseling, and support to pregnant women in rural areas. These workers can help bridge the gap between healthcare facilities and communities, ensuring that women receive the necessary care and information.

3. Telemedicine: Establish telemedicine services to enable pregnant women in remote areas to consult with healthcare providers without having to travel long distances. This can help address the issue of limited access to healthcare facilities and specialists.

4. Transportation Solutions: Develop innovative transportation solutions, such as mobile clinics or ambulances, to ensure that pregnant women can easily access healthcare facilities, especially in rural areas with limited transportation options.

5. Maternal Health Vouchers: Implement voucher programs that provide pregnant women with financial assistance to cover the costs of prenatal care, delivery, and postnatal care. This can help reduce financial barriers and improve access to essential maternal health services.

6. Maternal Health Education Campaigns: Launch targeted education campaigns to raise awareness about the importance of prenatal care, safe delivery practices, and postnatal care. These campaigns can be conducted through various channels, including radio, television, and community outreach programs.

7. Maternal Health Clinics: Establish dedicated maternal health clinics that provide comprehensive care for pregnant women, including prenatal check-ups, counseling, and support services. These clinics can serve as one-stop centers for all maternal health needs.

8. Public-Private Partnerships: Foster collaborations between public and private sectors to improve access to maternal health services. This can involve leveraging private sector resources and expertise to enhance the quality and availability of maternal healthcare.

9. Maternal Health Hotlines: Set up helplines or hotlines that pregnant women can call to seek advice, ask questions, and receive support from healthcare professionals. This can be particularly beneficial for women in remote areas who may have limited access to healthcare facilities.

10. Maternal Health Monitoring Systems: Develop and implement systems for monitoring maternal health indicators, such as maternal mortality rates and access to prenatal care. This data can help identify gaps in access and inform targeted interventions to improve maternal health outcomes.

These innovations aim to address the challenges faced by pregnant women in accessing maternal health services, particularly in rural and resource-limited settings. By improving access to care, these innovations have the potential to reduce maternal mortality and improve the overall health and well-being of pregnant women and their babies.

AI Innovations Description

The study conducted in southwestern Uganda aimed to understand the patterns of family support and its impact on viral load suppression among youth living with HIV (YLWH) aged 15 to 24 years. The study enrolled 88 YLWH who had been receiving antiretroviral therapy (ART) for at least 6 months. The primary outcome of interest was viral load suppression, defined as a viral load of ≤500 copies/mL.

The findings of the study revealed several factors associated with viral load suppression among YLWH. These factors included living with a parent, sibling, or spouse, having a primary caretaker with a regular income, and living or communicating with family at least twice a week. Additionally, YLWH who reported receiving moderate to high family support and perceived family support as helpful in the last 2 years were more likely to achieve viral load suppression. On the other hand, HIV stigma and depression were found to decrease viral load suppression.

Qualitative data from in-depth interviews highlighted the role of family relationships, economic insecurity, physical separation, HIV- and disclosure-related stigma, and past and ongoing family experiences with HIV/ART in shaping family support. These factors influenced feelings of abandonment, helplessness, discrimination, and economic or emotional challenges among YLWH.

Based on these findings, the study recommends future interventions that focus on contextual community approaches to encourage acceptance, disclosure, and resource mobilization for YLWH who rely on family support to appropriately use ART. These interventions should aim to address dysfunctional family relationships, economic insecurity, and stigma, and promote ongoing emotional, physical, and financial support from immediate family members to enhance adherence to medication and overall well-being of YLWH.

It is important to note that this study provides valuable insights into the role of family support in improving access to maternal health. However, further research and implementation of targeted interventions are needed to effectively address the challenges identified and improve maternal health outcomes for YLWH in resource-limited settings.

AI Innovations Methodology

The study described in the provided text aims to understand the patterns of family support and its impact on viral load suppression among youth living with HIV (YLWH) aged 15 to 24 years in southwestern Uganda. The methodology used in this study includes a mixed-method cross-sectional design, combining quantitative data analysis and qualitative interviews.

Quantitative data was collected from 88 eligible YLWH who had been receiving antiretroviral therapy (ART) for at least 6 months. The primary outcome of interest was viral load suppression, defined as a viral load of ≤500 copies/mL. Participants completed a structured questionnaire that collected data on various factors such as socio-demographics, health and depression, HIV disclosure, food insecurity, alcohol use, HIV stigma, and social support. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20. Univariate logistic regression was used to assess the associations between covariates and viral load suppression, and multivariable logistic regression was used to control for confounders.

Qualitative data was collected through in-depth interviews with a subset of 15 YLWH. These interviews aimed to gather detailed information on family and primary caretaker relationships, ART and disclosure experiences, pill-taking behavior, food insecurity, and types of family support. The interviews were conducted in the local language, digitally recorded, and later transcribed and translated into English. The data was analyzed using an inductive content analytic approach. The transcripts were coded, categories were generated, and themes were identified to explain how family support influences healthcare decisions and access to ART.

To simulate the impact of recommendations on improving access to maternal health, a methodology could include the following steps:

1. Identify the recommendations: Based on the study findings and existing evidence, identify specific recommendations that could improve access to maternal health. These recommendations could include interventions to enhance family support, increase awareness about maternal health services, improve healthcare infrastructure, or strengthen healthcare provider training.

2. Define the simulation model: Develop a simulation model that represents the current state of maternal health access and outcomes in the target population. The model should include relevant variables such as maternal mortality rates, access to prenatal care, utilization of skilled birth attendants, and availability of essential maternal health services.

3. Incorporate the recommendations: Modify the simulation model to incorporate the recommended interventions. Adjust the relevant variables in the model based on the expected impact of each recommendation. For example, if one recommendation is to increase awareness about maternal health services, the model could simulate an increase in the proportion of pregnant women seeking prenatal care.

4. Simulate the impact: Run the simulation model with the modified variables to simulate the impact of the recommendations on improving access to maternal health. Analyze the outcomes of interest, such as changes in maternal mortality rates or increased utilization of skilled birth attendants.

5. Evaluate the results: Assess the results of the simulation to determine the effectiveness of the recommendations in improving access to maternal health. Compare the simulated outcomes with the baseline data to measure the potential impact of the recommendations.

6. Refine and iterate: Based on the simulation results, refine the recommendations and the simulation model if necessary. Repeat the simulation process to further evaluate the impact of the refined recommendations.

By following this methodology, policymakers and healthcare stakeholders can gain insights into the potential impact of specific recommendations on improving access to maternal health. This information can guide decision-making and resource allocation to implement effective interventions.

Umbhali

Dima Health

Identifiers:

DOI: 10.1002/hsr2.467

Research Areas:

Community Interventions, Disparities, Food Security, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Mental Health, Quality of Care, Social Determinants, Substance Abuse, Technology and Innovations

Study Countries:

Uganda

Study Design:

Case-Control Study, Cross Sectional Study, Exploratory Study

Study Approach:

Mixed-methods, Qualitative, Quantitative

Participants Gender:

Male & Female

Yabelana ngalokhu: