“How am I going to live?”: exploring barriers to ART adherence among adolescents and young adults living with HIV in Uganda

Abstract Background Studies from sub-Saharan Africa (SSA) document how barriers to ART adherence present additional complications among adolescents and young adults living with HIV. We qualitatively explored barriers to ART adherence in Uganda among individuals age 14–24 to understand the unique challenges faced by this age group. Methods We conducted focus group (FG) discussions with Community Advisory Board members (n = 1), health care providers (n = 2), and male and female groups of adolescents age 14–17 (n = 2) and youth age 18–24 (n = 2) in Kampala, Uganda. FGs were transcribed verbatim and translated from Luganda into English. Two investigators independently reviewed all transcripts, developed a detailed codebook, achieved a pooled Cohen’s Kappa of 0.79 and 0.80, and used a directed content analysis to identify key themes. Results Four barriers to ART adherence emerged: 1) poverty limited adolescents’ ability to buy food and undercut efforts to become economically independent in their transition from adolescence to adulthood; 2) school attendance limited their privacy, further disrupting ART adherence; 3) family support was unreliable, and youth often struggled with a constant change in guardianship because they had lost their biological parents to HIV. In contrast peer influence, especially among HIV-positive youth, was strong and created an important network to support ART adherence; 4) the burden of taking multiple medications daily frustrated youth, often leading to so-called ‘drug holidays.’ Adolescent and youth-specific issues around disclosure emerged across three of the four barriers. Conclusions To be effective, programs and policies to improve ART adherence among youth in Uganda must address the special challenges that adolescents and young adults confront in achieving optimal adherence. For example, training on budgeting and savings practices could help promote their transition to financial independence. School staff could develop strategies to help students take their medications consistently and confidentially. While challenging to extend the range of services provided by HIV clinics, successful efforts will require engaging the family, peers, and larger community of health and educational providers to support adolescents and young adults living with HIV to live longer and healthier lives. Trial registration ClinicalTrials.gov Identifier: NCT02514356. Registered August 3, 2015

'Valve for Life': tackling the deficit in transcatheter treatment of heart valve disease in the UK.

Transcatheter aortic valve implantation (TAVI) is a proven treatment for life-threatening aortic valve disease, predominantly severe aortic stenosis. However, even among developed nations, access to TAVI is not uniform. The Valve for Life initiative was launched by the European Association of Percutaneous Cardiovascular Interventions in 2015 with the objective of improving access to transcatheter valve interventions across Europe. The UK has been identified as a country with low penetration of these procedures and has been selected as the fourth nation to be included in the initiative. Specifically, the number of TAVI procedures carried out in the UK is significantly lower than almost all other European nations. Furthermore, there is substantial geographical inequity in access to TAVI within the UK. As a consequence of this underprovision, waiting times for TAVI are long, and mortality among those waiting intervention is significant. This article reviews these issues, reports new data on access to TAVI in the UK and presents the proposals of the UK Valve for Life team to address the current problems in association with the British Cardiovascular Intervention Society

Extended Statement by the British Cardiovascular Intervention Society President Regarding Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) has now become the default intervention for severe, symptomatic aortic stenosis (AS) in inoperable and high-risk patients and patients at intermediate risk who are anatomically suitable for the transfemoral approach, under the guidance of a multidisciplinary heart team. Evidence is building for the use of TAVI in low-risk patients and as a result, the number of TAVI procedures in all developed nations is increasing dramatically. The number of TAVI procedures exceeded the number of isolated surgical aortic valve replacements in the US in 2015 and all surgical aortic valve replacements in 2018 according to the latest Transcatheter Valve Therapy Registry data.1 Although the UK is lagging behind most of these nations, the numbers of TAVI procedures is nevertheless increasing year by year. The British Cardiovascular Intervention Society (BCIS) has issued guidance as to how patients with AS should be managed and a service specification as to how TAVI should be performed.2 We hope this will go some way to standardising care across the UK for patients with AS but we are aware that much more needs to be done. BCIS is collaborating with the Valve for Life campaign to analyse inequities in TAVI provision in the UK and we hope to work with NHS commissioners to address this, and to encourage new centres to provide TAVI where local provision is inadequate or impossible with current facilities. The following document forms the basis of what will be a prolonged effort to improve TAVI provision in the UK and standardise its delivery.</p