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Adolescents living with HIV (ALHIV) have low antiretroviral therapy (ART) adherence, yet high levels of ART adherence are necessary to maximize treatment outcomes. Psychosocial factors such as depression and stigma the poor adherence. In this pilot study, we examine the preliminary impact of group-cognitive behavioral therapy (G-CBT) versus a family strengthening intervention delivered via multiple family group (MFG) in improving ART adherence among adolescents living with HIV (ALHIV) in Uganda.
Methods.
We analyzed data from a National Institute of Mental Health (NIMH)-funded pilot cluster-randomized trial (2020 to 2022) among 89 ALHIV, recruited from nine (9) clinics in Southern Uganda, an area hard-hit by HIV. Participants were aged 10 – 14 years, HIV positive, taking antiretroviral therapy, and living with a family. Adolescents were randomized, at the clinic level, to either the usual care arm receiving treatment as usual (n=29); treatment 1 arm receiving 10 sessions of MFG (n=34); or treatment arm 2, receiving 10 sessions of G-CBT (n=26). The interventions were delivered over a 3 month-period. Adherence was assessed at baseline, and four additional pharmacy visits. ART adherence was measured using pharmacy records, where good adherence was defined as taking 85% of prescribed pills. We used mixed-effects logistic regression analysis to examine the effect of the intervention on ART adherence, while controlling for clustering at the clinic.
Results.
The mean age was 12 years, 58% were female. Intervention main effect: We found significantly higher adherence in intervention groups than control, χ2(2) = 7.76, p=0.021. Time main effect: The main effects for time were also statistically significant χ2(4) = 39.67, p<0.001, showing gradually increasing adherence over time. Contrasts showed increasing adherence in the G-CBT group χ2(2) = 39.25, p<0.001 and MFG group χ2(2) = 20.66, p<0.001, but not control group, χ2(2) = 1.53, p=0.465. The Intervention-time interaction effect was also statistically significant χ2(6) = 27.65, p<0.001: Specifically, pairwise comparisons showed significantly higher adherence in G-CBT compared to MFG at visit 3, contrasts = -0.31 (95% CI: -0.51 – -0.11); and G-CBT vs. control, contrasts = 0.212 (95% CI: 0.002 – 0.423) at visit 4.
Conclusions and Implications.
G-CBT and MFG have the potential to improve ART adherence among adolescents, by offering more opportunities for normalization, positive peer modeling, social support and shared experiences. Moreover, G-CBT is a low-cost alternative to expensive individual therapy, especially in low resource settings that lack trained mental health care professionals.