Factors influencing the self-management youth living with HIV in Lesotho

Thesis (MNur)--Stellenbosch University, 2022.ENGLISH SUMMARY: Background: Many adolescents and youth live with the human immunodeficiency virus (HIV) worldwide. The HIV treatment goals and health outcomes of adolescents and youth living with HIV (YLWHIV) are lagging. One way to improve outcomes is through supporting YLWHIV to acquire self-management (SM) skills. Self-Management is a youth’s ability to take control of their health and adopt good health practices. Although SM is associated with improved health outcomes, condition-specific, environmental, individual and family contextual factors influence SM. Knowledge of contextual factors influencing SM of YLWHIV in Lesotho could assist in tailoring SM support strategies. Aim: The study aimed to describe the factors that influence SM of YLWHIV in Lesotho. The specific objectives were to determine the condition-specific, physical, and social environmental factors as well as the individual and family characteristics influencing SM of YLWHIV in Lesotho. Methods: An exploratory-descriptive, cross-sectional quantitative research design was used. Youth living with HIV (n=184), aged 15-24, were conveniently sampled from two HIV treatment sites in Lesotho. The data were collected through a validated self-report questionnaire available in English and Sesotho. Data analysis was done using the Statistical Package of Social Sciences (SPSS) version 27 to obtain descriptive and inferential statistics. The Stellenbosch University Health Research Ethics Committee waived parental consent for adolescents younger than 18. Results: Participants had high SM scores (mean 92.7%), which corresponded with their treatment outcomes. Almost all the participants (98.9%; n=181) indicated that they never missed a dose of their antiretroviral treatment (ART). All the participants (100%; n=183) had viral load values of less than 1000 copies/ml. Although SM scores were high, YLWHIV had lower item mean scores in relational and participatory components, which are crucial for their transitioning to adult care, negotiating condom use and accessing community services. High SM scores in this sample could be attributed to condition-specific factors, including once-daily doses (100%; n=182) and a longer duration on treatment (81.4%; n=149) on ART for more than 10 years). Regarding the physical and social environmental factors, participants had access to youth-friendly health services; 97.9% (n=179) were satisfied with the services. Regarding individual and family factors, participants were older (median age 22; IQR 4) and the majority had stable living conditions (61.7%; n=113) living with their current caregiver for more than 10 years). Individual strengths were associated with higher SM scores (p<0.01); mental health problems were associated with lower levels of SM (p<0.05). Conclusion: The study supports the notion that uncomplicated treatment regimens, longer duration on treatment, access to adolescent-friendly services, and stable living conditions may lead to better SM. However, further exploration of factors influencing SM across various healthcare settings and with more diverse YLWHIV are needed to contextualise SM support interventions for YLWHIV, particularly those transitioning to adult care, to ensure meeting global targets.AFRIKAANSE OPSOMMING: Agtergrond: Vele adolessente en jeugdiges wêreldwyd moet saamleef met die menslike immuniteitsgebreksvirus (MIV). MIV-behandelingsdoelwitte en gesondheidsuitkomste van adolessente en jeug wat met MIV leef (JMIVL) is agterblywend. Een manier om die uitkomste te verbeter, is om JMIVL met die verwerwing van selfbestuur (SB) te ondersteun. SB is ʼn jeugdige se vermoë om beheer oor hul gesondheid uit te oefen en om goeie gesondheidspraktyke aan te neem. Alhoewel SB met verbeterde gesondheidsuitkomste geassosieer word, is daar verskeie faktore wat SB beïnvloed. Hierdie faktore is toestand-spesifiek en sluit die omgewing asook die konteks van die individu en familie in. Kennis rondom die faktore wat die SB van JMIVL beïnvloed, kan gebruik word om SD-ondersteuningstrategieë vir JMIVL in Lesotho aan te pas. Doelstelling: Hierdie studie het beoog om die faktore wat die SB van JMIVL beïnvloed, te beskryf. Die spesifieke doelwitte was om die toestand-spesifieke, fisiese, en sosiale omgewingsfaktore, asook die individuele en familie-kenmerke wat die SB van JMIVL in Lesotho beïnvloed, te bepaal. Metodes: ʼn Verkennend-beskrywende, kwantitatiewe deursneestudie-ontwerp is gebruik. JMIVL (n=184), tussen die ouderdomme van 15 tot 24 jaar, is deur middel van ʼn geriefsteekproefneming by twee MIV-behandelingsplekke vir die navorsing gewerf. Die data is deur middel van ʼn gestaafde selfrapporteringsvraelys, beskikbaar in Engels en Sesotho, ingesamel. Die Statistiese Pakket van Sosiale Wetenskappe (SPSS) weergawe 27 is gebruik om die data-analise te doen ten einde beskrywende en afleibare statistieke te verkry. Die Universiteit van Stellenbosch se Gesondheidsnavorsing en etiekkomitee het ouerlike toestemming vir adolessente jonger as 18 opsygesit. Resultate: Deelnemers het hoë SB-tellings gehad (gemiddeld 92.7%). Die telling stem ooreen met hul behandelingsuitkomste. Amper al die deelnemers (98.9%; n=181) het aangedui dat hulle nooit ʼn dosis van hulle antiretrovirale behandeling (ARB) gemis het nie. Al die deelnemers (100%; n=183) het virale ladingswaardes van minder as 1000 kopieë/ml gehad. Alhoewel die SB-tellings hoog was, het JMIVL laer gemiddelde tellings in die komponente van verhoudings en deelname gehad. Hierdie komponente is deurslaggewend vir hul oorgang na volwasse sorg, onderhandeling van kondoomgebruik en toegang to gemeenskapsdienste. Hoë SB-tellings in hierdie groep kan aan toestand-spesifieke faktore toegeskryf word, insluitend dat dosisse slegs een maal per dag is (100%; n=182) en dat meeste van die deelnemers al vir ʼn langer tydperk op behandeling is (81.4%; n=149 op ARB vir meer as 10 jaar). Rakende die fisiese en sosiale omgewingsfaktore, het die navorsing aangedui dat deelnemers toegang tot jeug-vriendelik gesondheidsdienste het en dat 97.9% (n=179) tevrede was met die dienste. Rakende die individuele en familie faktore, is die deelnemers ouer jeugdiges (gemiddelde ouderdom van 22; IQR4) en meeste van hulle het stabiele lewensomstandighede (61.7%; n=113) bly al vir meer as 10 jaar saam met hulle huidige versorger). Individuele sterkpunte is geassosieer met hoër SD-tellings (p<0.01) en geestesgesondheidsprobleme is geassosieer met laer SD-vlakke (p<0.05). Slotsom: Hierdie studie ondersteun die opvatting dat behandelingsvoorskrifte wat nie ingewikkeld is nie, ʼn langer behandelingstydperk, toegang tot adolessente-vriendelike dienste, en stabiele lewensomstandighede tot beter SB lei. Verdere navorsing is egter nodig om die faktore wat SB by verskeie gesondheidsorg-omgewings beïnvloed te ondersoek. Navorsing wat meer diverse JMIVL insluit is ook nodig om SB-ondersteunende intervensies vir JMIVL binne konteks te plaas, veral vir diegene wat oorgaan na volwasse sorg. Sodoende kan wêreld-doelwitte bereik word. Sleutelwoorde: Jeugdiges, adolessente, jongmense, MIV en VIGS, self-bestuur.Master

Contextual factors influencing self-management of adolescents and youth living with HIV: A cross-sectional survey in Lesotho

HIV treatment outcomes of adolescents and youth living with HIV (AYLWH) are lagging. One way to improve outcomes is through supporting AYLWH to acquire self-management skills. Although self-management is associated with improved health outcomes, condition-specific, individual/family, and social/environmental contextual factors influence self-management. We aimed to describe factors influencing the self-management of AYLWH in Lesotho. A cross-sectional survey design was used. AYLWH (n = 183) aged 15–24 were conveniently sampled from two HIV treatment sites in Lesotho. Participants completed self-report questionnaires in English or Sesotho