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Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort

BACKGROUND: Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors–adolescents infected perinatally who survive without access to lifesaving treatment–remain unidentified and disconnected from heath systems, especially in high-prevale...

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Autores principales: Toska, Elona, Cluver, Lucie, Orkin, Mark, Bains, Anurita, Sherr, Lorraine, Berezin, McKenzie, Gulaid, Laurie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404343/
https://www.ncbi.nlm.nih.gov/pubmed/30841878
http://dx.doi.org/10.1186/s12889-019-6580-0
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author Toska, Elona
Cluver, Lucie
Orkin, Mark
Bains, Anurita
Sherr, Lorraine
Berezin, McKenzie
Gulaid, Laurie
author_facet Toska, Elona
Cluver, Lucie
Orkin, Mark
Bains, Anurita
Sherr, Lorraine
Berezin, McKenzie
Gulaid, Laurie
author_sort Toska, Elona
collection PubMed
description BACKGROUND: Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors–adolescents infected perinatally who survive without access to lifesaving treatment–remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV. METHODS: Quantitative interviews with N = 1063 adolescents living with HIV and N = 456 HIV-free community control adolescents (10–19 year olds) included educational experiences (enrolment, fee-free school, school feeding schemes, absenteeism, achievement), physical health, cognitive difficulties, mental health challenges (depression, stigma, and trauma), missing school to attend clinic appointments, and socio-demographic characteristics. Voluntary informed consent was obtained from adolescents and caregivers (when adolescent < 18 years old). Analyses included multivariate logistic regressions, controlling for socio-demographic covariates, and structural equation modelling using STATA15. RESULTS: ALHIV reported accessing educational services (enrolment, free schools, school feeding schemes) at the same rates as other adolescents (94, 30, and 92% respectively), suggesting that school is a valuable site for identification. Living with HIV was associated with poorer attendance (aOR = 1.7 95%CI1.1–2.6) and educational delay (aOR1.7 95%CI1.3–2.2). Adolescents who reported educational delay were more likely to be older, male, chronically sick and report more cognitive difficulties. A path model with excellent model fit (RMSEA = 0.027, CFI 0.984, TLI 0.952) indicated that living with HIV was associated with a series of poor physical, mental and cognitive health issues which led to worse educational experiences. CONCLUSION: Schools may provide an important opportunity to identify unreached adolescents living with HIV and link them into care, focusing on adolescents with poor attendance, frequent sickness, low mood and slow learning. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Improved linkages to care for adolescents living with HIV, in particular educational support services, are necessary to support scholastic achievement and long-term well-being, by helping them to cope with physical, emotional and cognitive difficulties.
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spelling pubmed-64043432019-03-18 Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort Toska, Elona Cluver, Lucie Orkin, Mark Bains, Anurita Sherr, Lorraine Berezin, McKenzie Gulaid, Laurie BMC Public Health Research Article BACKGROUND: Many adolescents living with HIV remain disconnected from care, especially in high-prevalence settings. Slow progressors–adolescents infected perinatally who survive without access to lifesaving treatment–remain unidentified and disconnected from heath systems, especially in high-prevalence settings. This study examines differences in educational outcomes for ALHIV, in order to i) identify educational markers for targeting HIV testing, counselling and linkages to care, and ii) to identify essential foci of educational support for ALHIV. METHODS: Quantitative interviews with N = 1063 adolescents living with HIV and N = 456 HIV-free community control adolescents (10–19 year olds) included educational experiences (enrolment, fee-free school, school feeding schemes, absenteeism, achievement), physical health, cognitive difficulties, mental health challenges (depression, stigma, and trauma), missing school to attend clinic appointments, and socio-demographic characteristics. Voluntary informed consent was obtained from adolescents and caregivers (when adolescent < 18 years old). Analyses included multivariate logistic regressions, controlling for socio-demographic covariates, and structural equation modelling using STATA15. RESULTS: ALHIV reported accessing educational services (enrolment, free schools, school feeding schemes) at the same rates as other adolescents (94, 30, and 92% respectively), suggesting that school is a valuable site for identification. Living with HIV was associated with poorer attendance (aOR = 1.7 95%CI1.1–2.6) and educational delay (aOR1.7 95%CI1.3–2.2). Adolescents who reported educational delay were more likely to be older, male, chronically sick and report more cognitive difficulties. A path model with excellent model fit (RMSEA = 0.027, CFI 0.984, TLI 0.952) indicated that living with HIV was associated with a series of poor physical, mental and cognitive health issues which led to worse educational experiences. CONCLUSION: Schools may provide an important opportunity to identify unreached adolescents living with HIV and link them into care, focusing on adolescents with poor attendance, frequent sickness, low mood and slow learning. Key school-based markers for identifying unreached adolescents living with HIV may be low attendance, frequent sickness, low mood and slow learning. Improved linkages to care for adolescents living with HIV, in particular educational support services, are necessary to support scholastic achievement and long-term well-being, by helping them to cope with physical, emotional and cognitive difficulties. BioMed Central 2019-03-06 /pmc/articles/PMC6404343/ /pubmed/30841878 http://dx.doi.org/10.1186/s12889-019-6580-0 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Toska, Elona
Cluver, Lucie
Orkin, Mark
Bains, Anurita
Sherr, Lorraine
Berezin, McKenzie
Gulaid, Laurie
Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort
title Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort
title_full Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort
title_fullStr Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort
title_full_unstemmed Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort
title_short Screening and supporting through schools: educational experiences and needs of adolescents living with HIV in a South African cohort
title_sort screening and supporting through schools: educational experiences and needs of adolescents living with hiv in a south african cohort
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6404343/
https://www.ncbi.nlm.nih.gov/pubmed/30841878
http://dx.doi.org/10.1186/s12889-019-6580-0
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