title: Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda.
abstract: Studies from sub-Saharan Africa indicate that children made vulnerable by poverty have been disproportionately affected by HIV with many exposed via mother-to-child transmission. For youth living with HIV, adherence to life-saving treatment regimens are likely to be affected by the complex set of economic and social circumstances that challenge their families and also exacerbate health problems. Using baseline data from the National Institute of Child and Human Development (NICHD) funded Suubi+Adherence study, we examined the extent to which individual and composite measures of equity predict self-reported adherence among Ugandan adolescents aged 10-16 (n = 702) living with HIV. Results showed that greater asset ownership, specifically familial possession of seven or more tangible assets, was associated with greater odds of self-reported adherence (OR 1.69, 95% CI: 1.00-2.85). Our analyses also indicated that distance to the nearest health clinic impacts youth's adherence to an ARV regimen. Youth who reported living nearest to a clinic were significantly more likely to report optimal adherence (OR 1.49, 95% CI: 0.92-2.40). Moreover, applying the composite equity scores, we found that adolescents with greater economic advantage in ownership of household assets, financial savings, and caregiver employment had higher odds of adherence by a factor of 1.70 (95% CI: 1.07-2.70). These findings suggest that interventions addressing economic and social inequities may be beneficial to increase antiretroviral therapy (ART) uptake among economically vulnerable youth, especially in sub-Saharan Africa. This is one of the first studies to address the question of equity in adherence to ART among economically vulnerable youth with HIV.
authors.affiliation: a Columbia University School of Social Work, International Center for Child Health and Asset Development , New York , NY , USA.
authors.forename: Laura Gauer
authors.initials: LG
authors.lastname: Bermudez
authors.affiliation: b Department of International Health, Social and Behavioral Interventions Program , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.
authors.forename: Larissa
authors.initials: L
authors.lastname: Jennings
authors.affiliation: a Columbia University School of Social Work, International Center for Child Health and Asset Development , New York , NY , USA.
authors.forename: Fred M
authors.initials: FM
authors.lastname: Ssewamala
authors.affiliation: c School of Social Service Administration , University of Chicago , Chicago , IL , USA.
authors.forename: Proscovia
authors.initials: P
authors.lastname: Nabunya
authors.affiliation: d HIV Center for Clinical and Behavioral Studies , New York State Psychiatric Institute and Columbia University Medical Center , New York , NY , USA.
authors.forename: Claude
authors.initials: C
authors.lastname: Mellins
authors.affiliation: e McSilver Institute for Poverty Policy and Research, Silver School of Social Work , New York University , New York , NY , USA.
authors.forename: Mary
authors.initials: M
authors.lastname: McKay
mesh_terms: D000293:Adolescent; D000554:Ambulatory Care Facilities; D017028:Caregivers; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011203:Poverty; D057566:Self Report; D014454:Uganda
keywords: ART adherence; Equity; HIV; Suubi; Uganda; assets; youth