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.