Adolescent clubs and self-efficacy linked to better HIV outcomes

Adolescents living with HIV (ALHIV) face psychosocial challenges that
could affect HIV treatment outcomes. Peer support networks and aspects of
well-being, including self-efficacy, self-esteem, and social capital,
could ameliorate these challenges. This retrospective analysis describes
participation in existing facility-based adolescent clubs and the
associations between club attendance, adolescent well-being, and HIV
treatment outcomes. Data were collected through interviews with a
sub-sample of adolescents aged 10-19 years and medical record abstraction
of all adolescents attending HIV services at seven clinics in Tanzania.
Independent variables included adolescent club attendance, self-efficacy,
self-esteem, symptoms of depression/anxiety, social capital, and other
health utilization or HIV experience characteristics. Study outcomes
included visit adherence, viral suppression (<1000 cp/ml), and
retention. Of 645 adolescents, 75% attended clubs at least once, with a
median of eight club sessions attended over a two-year period. Mental
distress, or symptoms of depression and anxiety, was prevalent, with 67%
of the adolescents scoring above a recognized cut-off of >5.
Adolescents who attended 10 or more clubs, compared to those not attending
any clubs over a two-year period, were at an almost three-fold increased
odds of having good visit adherence (odds ratio [OR] 2.72, 95% confidence
interval [CI]: 1.25, 5.94). Club attendance was also strongly associated
with retention in the following year, with adolescents attending some
clubs (<10) having three-times the odds of being retained (OR 3.01;
95%CI: 1.86, 4.87) and adolescents attending more frequently (10+) having
over seven-times the odds (OR 7.29; 95%CI: 4.34, 12.22). Among the
sub-sampled adolescents who were interviewed, being in the top
self-efficacy tertile was positively associated with viral suppression (OR
3.04, 95%CI: 1.08, 8.60) and retention (OR 4.44, 95%CI: 1.19, 17.40).
Attending the HIV clinic with a guardian/treatment supporter (OR 3.29,
95%CI: 1.17, 9.22) was also associated with viral suppression, and social
capital was associated with club attendance (B1 3.24, 95%CI 0.64, 5.85).
This study points to the need for comprehensive psychosocial support
interventions for ALHIV. Self-efficacy, social capital, and treatment
support are important characteristics that facilitate better health
outcomes among adolescents. However, many ALHIV either never attended or
did not regularly attend clubs, mitigating the real-world impact of such
interventions. Further research is needed to identify barriers to club
attendance and interventions that promote adolescent well-being,
resilience, and guardian/treatment supporter engagement.