Relationships Between Adverse Childhood Experiences and Clinical Outcomes Among Adolescents Living with Perinatally Acquired HIV: A Mixed-Methods Analysis Public
Clevenger, Emma (Spring 2022)
Abstract
Background: Globally, adolescents living with HIV (ALHIV) bear a disproportionate burden of the HIV epidemic and this disparity is more pronounced in low-resource settings. In addition to increased risk of poor health outcomes, ALHIV are also more likely to experience adverse childhood experiences (ACEs). ACEs have been shown to have negative impacts on mental and physical health. Given the growing population of ALHIV, there is a need to better understand their challenges and lived experiences of this population, including ACEs and their impact on HIV care.
Objective: This study aimed to understand the effects of ACEs on the health of perinatally infected ALHIV, from the perspective of adolescents, caregivers, and providers; explore the relationship between ACEs and virological outcomes among ALHIV; and explore strategies that foster resilience among ALHIV following adversity, including the mitigating role of social support.
Methods: 130 randomly selected ALHIV engaged in care at study sites in Western Kenya participated in a survey. Purposive sampling was used to select 45 of these adolescents for focus groups (FGDs) (n=30) or in-depth interviews (IDIs) (n=15). Ten caregivers to ALHIV and 15 healthcare providers were recruited for additional interviews. Descriptive statistics and tests of association were used to assess relationships between ACEs and clinical outcomes; thematic analysis was used to identify recurring themes in the FGD and IDI data.
Results: The prevalence of ACEs was high, with a mean of 1.2 (SD=1.8) ACEs experienced by ALHIV. Several ACEs were significantly associated with poorer virological or clinical outcomes, and results varied by gender. A number of themes emerged from the qualitative findings, in which all participant types spoke of ALHIV experiences with abuse, neglect, and household challenges, and potential mitigators were proposed based upon personal experiences or observations.
Conclusions: Findings suggests that ACEs may negatively impact the later clinical outcomes of adolescents living with perinatally acquired HIV. Additional research is necessary in order to elucidate the pathways between ACEs and negative health outcomes in this population, and to further inform programs and policies to prevent ACEs and reduce their impact on engagement in care and the health and well-being of ALHIV.
Table of Contents
CHAPTER I: INTRODUCTION 1
1.1 INTRODUCTION AND RATIONALE 1
1.2 PROBLEM STATEMENT 2
1.3 PURPOSE STATEMENT 2
1.4 OBJECTIVES 2
1.5 SIGNIFICANCE STATEMENT 3
1.6 DEFINITION OF TERMS 3
CHAPTER II: LITERATURE REVIEW 5
2.1 INTRODUCTION 5
2.2 ADOLESCENTS LIVING WITH HIV IN KENYA 5
2.3 PERINATALLY INFECTED ADOLESCENTS LIVING WITH HIV 7
2.4 PREDICTORS OF ADHERENCE AND CLINICAL OUTCOMES IN ADOLESCENTS LIVING WITH PERINATALLY ACQUIRED HIV 10
2.5 CHILDHOOD ADVERSITIES AND HIV OUTCOMES 11
2.6 CONCLUSION 14
CHAPTER III: MANUSCRIPT 15
ABSTRACT 15
INTRODUCTION 17
METHODS 19
Research Design 19
Population and Sample 19
Procedures 19
Instruments 20
Analysis 21
Ethical Considerations 23
RESULTS 24
Characteristics of ALHIV Sample 24
Prevalence of ACEs 24
Effects of ACEs 25
Overall 25
Abuse 25
Neglect 27
Household challenges 29
Potential mitigators 30
DISCUSSION 31
CHAPTER IV: CONCLUSION 35
TABLES 37
REFERENCES 43
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