Identifying Adolescents at Highest Risk of ART Non-adherence, Using the World Health Organization-Endorsed HEADSS and HEADSS+ Checklists

Journal article

Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO’s HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health

Authors: Cluver, LD; Shenderovich, Y; Seslija, M; Zhou, S; Toska, E

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Springer
• Journal: AIDS and Behavior
• Volume: 28
• Issue: 1
• Pages: 141-153
• Publication date: 2023-08-17
• DOI: 10.1007/s10461-023-04137-6
• EISSN: 1573-3254
• ISSN: 1090-7165
• Language: English
• Keywords: Internal medicine; Mental health; Population; Public health; Psychology; Social support; Medicine; Demography; Reproductive health; Psychiatry; Cohort; Health psychology; Environmental health; Depression (economics); Nursing