{"title":"Pathways between adverse childhood experiences and viral suppression among male HIV-infected adolescents in South Africa.","authors":"Rachel Kidman, Sabera Hossain, Wei Hou, Avy Violari","doi":"10.1080/09540121.2024.2332451","DOIUrl":null,"url":null,"abstract":"<p><p>Fewer adolescents achieve viral suppression compared to adults. One impediment may be a history of adverse childhood experiences (ACEs). To better develop targets and timeframes for intervention, this study created more robust estimates of the impact of cumulative adversity on viral suppression, tested whether the association is sensitive to the timing of adversity, and simultaneously tested several potential mechanisms. We focus on males, who have lower viral suppression than females and who may contribute to disproportionate incidence among young women. We recruited 251 male perinatally HIV-infected adolescents aged 15-19 from HIV clinics in Soweto, South Africa. Adversity was captured using the Adverse Childhood Experience - International Questionnaire (ACE-IQ). Viral load was measured using blood samples; viral suppression was defined as <20 copies/mL. Indicators of medication adherence, depression, post-traumatic stress disorder (, and substance misuse were captured. A series of pathway analysis were performed. Our sample experienced a median of 7 lifetime and 4 past-year adversities. Less than half (44%) exhibited viral suppression. Adversity demonstrated a significant association with suppression; depression mediated the association. Primary prevention of adversity among children living with HIV is paramount, as is addressing the subsequent mental and behavioral health challenges that impede viral suppression among adolescents.</p>","PeriodicalId":48370,"journal":{"name":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","volume":" ","pages":"36-44"},"PeriodicalIF":1.2000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11283965/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Aids Care-Psychological and Socio-Medical Aspects of Aids/hiv","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1080/09540121.2024.2332451","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/31 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"HEALTH POLICY & SERVICES","Score":null,"Total":0}
引用次数: 0
Abstract
Fewer adolescents achieve viral suppression compared to adults. One impediment may be a history of adverse childhood experiences (ACEs). To better develop targets and timeframes for intervention, this study created more robust estimates of the impact of cumulative adversity on viral suppression, tested whether the association is sensitive to the timing of adversity, and simultaneously tested several potential mechanisms. We focus on males, who have lower viral suppression than females and who may contribute to disproportionate incidence among young women. We recruited 251 male perinatally HIV-infected adolescents aged 15-19 from HIV clinics in Soweto, South Africa. Adversity was captured using the Adverse Childhood Experience - International Questionnaire (ACE-IQ). Viral load was measured using blood samples; viral suppression was defined as <20 copies/mL. Indicators of medication adherence, depression, post-traumatic stress disorder (, and substance misuse were captured. A series of pathway analysis were performed. Our sample experienced a median of 7 lifetime and 4 past-year adversities. Less than half (44%) exhibited viral suppression. Adversity demonstrated a significant association with suppression; depression mediated the association. Primary prevention of adversity among children living with HIV is paramount, as is addressing the subsequent mental and behavioral health challenges that impede viral suppression among adolescents.
与成年人相比,能达到病毒抑制效果的青少年较少。其中一个障碍可能是童年的不良经历(ACEs)。为了更好地制定干预目标和时间框架,本研究对累积性逆境对病毒抑制的影响进行了更可靠的估计,测试了这种关联是否对逆境发生的时间敏感,并同时测试了几种潜在的机制。我们的研究重点是男性,他们的病毒抑制率比女性低,而且可能导致年轻女性的发病率过高。我们从南非索韦托的 HIV 诊所招募了 251 名 15-19 岁的围产期感染 HIV 的男性青少年。我们使用 "童年不良经历--国际问卷"(ACE-IQ)来了解青少年的不良经历。病毒载量通过血液样本进行测量;病毒抑制定义为