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Bernays, Sarah, Lariat, Joni, Cowan, Frances 
ORCID: https://orcid.org/0000-0003-3087-4422, Senzanje, Beula, Willis, Nicola and Mupambireyi Nenguke, Zivai
(2023)
'“They test my blood to know how much blood is in my body”: The untapped potential of promoting viral load literacy to support viral suppression among adolescents living with HIV'. Journal of the International AIDS Society, Vol 26, Issue 10, e26153.
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Abstract
Introduction: Achieving sustained HIV viral suppression is a key strategy to optimise the health and well-being of those living with HIV. Sub-optimal adherence to antiretroviral therapy (ART) in adolescents and young people living with HIV (AYPLHIV) in Southern Africa, due to a range of social and contextual factors including poor mental health, has presented a substantial challenge to meeting targets aimed towards improving treatment outcomes and reducing transmission. With the increasing availability of viral load testing in Southern Africa, there is an opportunity to better understand the relationship between viral load (VL) literacy, well-being, and adherence among adolescents.
Methods: We conducted qualitative interviews with 45 AYPLHIV aged 10-24 years in 3 districts (urban, peri urban, and rural) in Zimbabwe. The sample was purposively selected to represent a range of experiences related to HIV status disclosure, gender, marital status, and treatment experience. Separate workshops were conducted with 18 health care workers (HCWs) and 20 caregivers to better understand existing support mechanisms to AYPLHIV accessing ART. We used thematic analysis to examine adolescent VL literacy, treatment support networks, experiences of clinic interactions, viral load testing procedures, and barriers to adherence.
Results: VL literacy was consistently under-developed among participants. Comprehension of phrases commonly heard during clinic visits such as TND (target not detected) and ‘high’ and ‘low’ viral load were better understood by older participants. VL testing was predominantly understood as a clinical procedure that enables HCWs to monitor treatment adherence. Conspicuously absent throughout the interviews were descriptions of how viral suppression improves health and quality of life, likely fosters well-being and enhances self-esteem, enables participation in education and social activities, and eliminates the risk of onward transmission.
Conclusions: It is imperative that we reconsider how routine VL monitoring is communicated to and understood by AYPLHIV. Reframing ART, including VL test results, in terms of the psychosocial benefits that viral suppression can generate is likely to be crucial to motivating AYPLHIV to maintain optimal treatment engagement and develop self-management approaches as they move into adulthood. Access to accurate information tailored to individual concerns and circumstances can support AYPLHIV to achieve well-being.
| Item Type: | Article |
|---|---|
| Subjects: | WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections WS Pediatrics > By Age Groups > WS 460 Adolescence (General) |
| Faculty: Department: | Clinical Sciences & International Health > International Public Health Department |
| Digital Object Identifer (DOI): | https://doi.org/10.1002/jia2.26153 |
| Depositing User: | Rachel Dominguez |
| Date Deposited: | 26 Oct 2023 12:19 |
| Last Modified: | 26 Oct 2023 12:30 |
| URI: | https://archive.lstmed.ac.uk/id/eprint/23002 |
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