Achieving equity in HIV-treatment outcomes: can social protection improve adolescent ART-adherence in South Africa?

Figures & data

Table 1. Socio-demographic, health and social protection factors for HIV-positive adolescents (n = 1059).

Comparison of included and excluded participants
	HIV+ (n = 1060)	Excluded (n = 116)	Sig.
Age (mean, SD)	13.8, 2.834	14.8, 2.91	z = 1.96, p = .671
Female (n, %)	587, 55.2	66, 56.9	χ^2(df) = .098(1), p = .769
Rural (n, %)	228, 21.4	26, 2.2	χ^2(df) = .050(1), p = .813
Included participants: descriptive analyses
Factor grouping	Factor	Category	n (%)	Mean (SD)
HIV-related outcomes	Adherence	Past-week non-adherence	385 (36.4)
		Past-year non-adherence	554 (52.3)
	Opportunistic infections	Number of OIs: sores, TB, shingles and mouth ulcers		1.7 (1.4)
	Most recent viral load (n = 201)	Detectable >75 ml copies	120 (45.1)
Socio-demographic factors	Age	Age in years		13.8 (2.8)
		10–14 years old	659 (62.2)
		15–19 years old	400 (37.8)
	Gender	Female	583 (55.1)
		Male	476 (44.9)
	Language	Xhosa	1027 (97.0)
	Housing	Informal shacks/settlements	198 (18.7)
		Formal	860 (81.3)
	Location	Urban	828 (78.2)
		Rural	227 (21.4)
	Education level	Highest grade completed		5.8 (2.6)
	Orphanhood	Maternal orphan	463 (43.7)
		Paternal orphan	319 (30.1)
Health, HIV and medication-related factors	Mode of HIV infection	Perinatal infection	708 (66.9)
		Horizontal infection	351 (33.1)
	Caregiver AIDS-related characteristics	Carer AIDS-symptomatic	45 (4.2)
		Carer taking ART	215 (20.3)
	Knowledge of HIV status	Adolescent knows they are HIV positive	793 (74.9)
	Access to antiretroviral medicine	Time on treatment (years)		5.9 (4.5)
	Health-specific factors	Poor past-month health status	625 (59.0)
		Travel to clinic more than one hour	120 (11.3)
		Recent hospital visit for illness	542 (51.2)
Social protection provisions	Cash	Any government welfare grant	1,002 (94.7)
		Food security (past week 2 meals/day)	820 (77.4)
		School feeding scheme	985 (93.0)
		School access	487 (46.0)
		Access to clothing	863 (81.5)
	Care	HIV support group	141 (13.3)
		Sports group	460 (43.6)
		Choir/art group	156 (14.7)
		Positive parenting	442 (41.7)
		Parental supervision/monitoring	432 (40.8)

Table 2 Associations of past-week self-reported non-adherence.

A. Number of opportunistic symptoms (n = 1059)^a
Covariates	B	SE	Beta
Age (years)	.020	.032	.041
Female gender (Y/N)	.025	.090	.009
Xhosa language (Y/N)	.362	.254	.046
Informal housing (Y/N)	.170	.117	.049
Rural location (Y/N)	–.051	.112	–.015
Highest grade completed	–.063	.029	–.119*
Maternal orphan (Y/N)	.100	.097	.037
Paternal orphan (Y/N)	–.035	.097	–.012
Perinatal infection (Y/N)	.004	.164	.001
Caregiver HIV-sickness (Y/N)	.456	.219	.071*
Caregiver on ARVs (Y/N)	–.025	.119	–.008
Knows own HIV-positive status (Y/N)	.114	.117	.035
Time on treatment (years)	–.028	.013	–.094*
Clinic travel time >1 hour (Y/N)	.341	.138	.082*
Past-month poor health (Y/N)	.685	.188	.118***
Recent hospital visit for illness	–.020	.092	–.007
Potential associated factor
Past-week self-reported non-adherence (Y/N)	.269	.095	.093**
***p < .001, **p < .005, *p < .05.
^aAll variables shown are entered simultaneously.
B. Detectable viral load (>75 ml copies) (n = 266)^a
Covariates	aOR	95% CI
Age	1.123	.926–1.362
Female gender (Y/N)	1.056	.599–1.859
Xhosa language (Y/N)	.887	.242–3.241
Informal housing (Y/N)	1.178	.567–2.446
Rural location (Y/N)	1.062	.520–2.168
Highest grade completed	.925	.758–1.127
Maternal orphan (Y/N)	1.199	.660–2.177
Paternal orphan (Y/N)	1.585	.880–2.854
Perinatal infection (Y/N)	2.668*	1.059–6.722
Caregiver HIV-sickness (Y/N)	1.103	.303–4.016
Caregiver on ARVs (Y/N)	1.683	.842–3.365
Knows own HIV-positive status (Y/N)	1.783	.906–3.510
Time on treatment (years)	.974	.896–1.058
Clinic travel time >1 hr (Y/N)	.775	.285–2.107
Past-month poor health (Y/N)	2.351	.726–7.617
Recent hospital visit for illness	.939	.534–1.651
Potential associated factor
Past-week self-reported non-adherence (Y/N)	1.976*	1.131–3.450

***p < .001, **p < .005, *p < .05.

^aAll variables shown are entered simultaneously.

Table 3. Logistic regression of all potential social protection factors and covariates.

	Outcome: Past-week self-reported non-adherence
	OR	95% CI	p-Value
Stage 1: All potential covariates and social protection factors
Age (years)	1.052	.946–1.170	.349
Female gender	1.133	.826–1.554	.438
Xhosa language (Y/N)	2.430^a	.875–6.748	.088
Informal housing (Y/N)	.775	.525–1.144	.199
Rural location (Y/N)	1.249	.866–1.802	.234
Highest grade completed	.972	.881–1.071	.564
Maternal orphan (Y/N)	1.002	.728–1.381	.989
Paternal orphan (Y/N)	1.123	.816–1.546	.475
Perinatal Infection (Y/N)	.951	.556–1.627	.856
Caregiver AIDS-sickness (Y/N)	1.082	.541–2.163	.823
Caregiver on ARVs (Y/N)	1.216	.828–1.785	.318
Knows own HIV-positive status (Y/N)	.711^a	0482–1.049	.085
Time on treatment (years)	1.000	.958–1.043	.999
Clinic travel time >1 hour (Y/N)	1.668*	1.082–2.572	.020
Past-month poor health (Y/N)	1.346	.745–2.432	.325
Recent hospital visit for illness (Y/N)	.626**	.463–.846	.002
Cash – Food security (Y/N)	.668*	.463–.966	.032
Cash – School access (Y/N)	1.019	.750–1.384	.905
Cash – Clothing access (Y/N)	.843	.565–1.259	.405
Care – HIV support group (Y/N)	.682^a	.431–1.077	.100
Care – Sport group (Y/N)	1.370^a	.991–1.894	.057
Care – Choir/ arts group (Y/N)	1.061	.697–1.617	.782
Care – Positive parenting (Y/N)	1.043	.767–1.419	.786
Care – Parental supervision/monitoring (Y/N)	.568***	.411–.785	.001
Stage 2: All covariates and social protection significant <.1
Xhosa language (Y/N)	1.803	.775–4.199	.171
Clinic travel time >1 hour (Y/N)	1.387	.929–2.071	.110
Recent hospital visit for illness (Y/N)	.542***	.416–.705	<.001
Knows own HIV-positive status	.772	.568–1.050	.099
Cash – Food security (Y/N)	.551***	.407–.746	<.001
Care – HIV support group (Y/N)	.636*	.417–.970	.035
Care – Sport group (Y/N)	1.140	.874–1.486	.333
Care – Good parental supervision/monitoring (Y/N)	.524***	.398–.690	<.001
Stage 3: All covariates and social protections significant <.05
Recent hospital visit for illness (Y/N)	.552***	.426–.716	<.001
Cash – Food security (Y/N)	.565***	.418–.763	<.001
Care – HIV support group (Y/N)	.603*	.401–.906	.015
Care – Good parental supervision/monitoring (Y/N)	.557***	.426–.728	<.001

Note: All variables entered simultaneously in each stage.

***p < .001, **p < .005, *p < .05, ^aP < .10.

Figure 1. Marginal effects model testing for additive effects of combination social protections on adolescent ART-adherence.

Table 4. Logistic regression of all significant potential social protection factors, interaction terms and covariates.

	Outcome: Past-week self-reported non-adherence
	OR	95% CI	p-Value
Main effects
Recent hospital visit for illness (Y/N)	.552***	.426–.716	<.001
Cash – Food security (Y/N)	.565***	.418–.763	.003
Care – HIV support group (Y/N)	.603**	.401–.906	<.001
Care – Parental supervision/monitoring (Y/N)	.557***	.426–.728	<.001
Conditional and interaction effects
Recent hospital visit for illness (Y/N)	.555***	.427–.720	<.001
Cash – Food security (Y/N)	.548**	.365–.825	.007
Care – HIV support group (Y/N)	.620	.262–1.470	.020
Care – Parental supervision/monitoring (Y/N)	.492*	.274–.833	.001
Interaction – Food security BY HIV support group	.937	.332–2.643	.727
Interaction –Parental supervision BY HIV support group	1.619	.282–9.288	.567
Interaction – Parental supervision BY Food security	1.168	.599–2.278	.216
Interaction – Food security BY HIV support group BY Parental supervision	.568	.073–4.430	.481

***p < .001, **p < .005, *p < .05.