Identifying adolescents at highest risk of ART non-adherence, using the World Health Organization-endorsed HEADSS and HEADSS+ checklists

Publication Type: Journal article
Year: 2023
Author(s):  Cluver, L. D., Shenderovich, Y., Seslija, M., Zhou, S., Toska, E., Armstrong, A., ... & Sherr, L. 
Unit: AARHub
Journal: AIDS and Behaviour
DOI:   https://doi.org/10.1007/s10461-023-04137-6 

Abstract: "Brief tools are necessary to identify adolescents at greatest risk for ART non-adherence. From the WHO’s HEADSS/HEADSS+ adolescent wellbeing checklists, we identify constructs strongly associated with non-adherence (validated with viral load). We conducted interviews and collected clinical records from a 3-year cohort of 1046 adolescents living with HIV from 52 South African government facilities. We used least absolute shrinkage and selection operator variable selection approach with a generalized linear mixed model. HEADSS constructs most predictive were: violence exposure (aOR 1.97, CI 1.61; 2.42, p < 0.001), depression (aOR 1.71, CI 1.42; 2.07, p < 0.001) and being sexually active (aOR 1.80, CI 1.41; 2.28, p < 0.001). Risk of non-adherence rose from 20.4% with none, to 55.6% with all three. HEADSS+ constructs were: medication side effects (aOR 2.27, CI 1.82; 2.81, p < 0.001), low social support (aOR 1.97, CI 1.60; 2.43, p < 0.001) and non-disclosure to parents (aOR 2.53, CI 1.91; 3.53, p < 0.001). Risk of non-adherence rose from 21.6% with none, to 71.8% with all three. Screening within established checklists can improve identification of adolescents needing increased support. Adolescent HIV services need to include side-effect management, violence prevention, mental health and sexual and reproductive health."

Citation: Cluver, L. D., Shenderovich, Y., Seslija, M., Zhou, S., Toska, E., Armstrong, A., ... & Sherr, L. (2023). Identifying adolescents at highest risk of ART non-adherence, using the World Health Organization-endorsed HEADSS and HEADSS+ checklists. AIDS and Behavior, 1-13.