Psychosocial and environmental correlates of clinical and immuno-virological outcomes in HIV-infected adolescents on art in Myanmar: qualitative component

INTRODUCTION: In 2015, a research study of medical outcomes of 177 adolescents living with HIV and on anti-retroviral treatment in the MSF Dawei HIV clinic was undertaken. A qualitative research component on the specific needs of adolescents was included, as there is very little research about this vulnerable group. METHODS: of the total cohort in the Dawei HIV clinic, 177 adolescents were identified ranging in age from 10 - 19 years old. All were screened for depressive symptoms with the patient health questionnaire-9 for adolescents (PHQ-9). Twelve adolescents and 10 caregivers were invited to participate in individual in-depth interviews and 10 healthcare providers participated in focus group discussions. Open-ended questions were pre-determined and discussions guided by a research assistant. The results were recorded, transcribed and translated from Myanmar to English for analysis. Grounded theory was used to develop a coding framework with the aid of NvivoPro 11.0 software. RESULTS: one adolescent in the cohort scored in the category of mild-signs of depression (Score = 6) on the PHQ-9. All others scored below the threshold. The dominant themes that emerged in the individual interviews included four major categories: the value of managing disclosure of HIV status to facilitate adherence to treatment, needs for HIV knowledge and communication skills for primary caregivers, the process of adherence skills development and calls for adapted services to the social and emotional needs of adolescents. CONCLUSION: the results reveal clear areas for the healthcare provider team to adapt their approaches for adolescents living with HIV. In addition to the multidisciplinary approach already in place, a role for including caregivers and adolescents as active agents in their own disease-management is desirable and feasible. Permitting families to speak openly in clinical, counselling, and group sessions will enhance communication skills, and prepare adolescents more effectively to gradually adopt responsibility for self-care.