Case study: multisystemic therapy for adolescents who engage in HIV transmission risk behaviors.
ABSTRACT To present a case study using multisystemic therapy (MST), an intensive family focused psychotherapy. For the clinical trial from which this case was drawn, MST was adapted to address multiple human immunodeficiency virus (HIV) transmission risk behaviors in HIV-infected youth. Targeted behaviors included medication nonadherence, risky sexual behaviors, and substance use.
One young woman's transmission risk behaviors are described, followed by a description of the MST procedures used to identify and treat the primary drivers of these risk behaviors. Outcome measures were self-report, urine screens, and blood draws.
At discharge, the young woman showed significant improvements in medication adherence and related health status (e.g., reduced HIV viral load), healthier sexual behaviors, and reduced substance use. Importantly, neither her boyfriend nor her newborn tested positive for HIV.
Findings from this case study suggest that MST has the potential to reduce transmission risk behaviors among teens with HIV.
Full-textDOI: · Available from: Deborah A Ellis, Dec 15, 2014
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ABSTRACT: Children born with HIV in the 1980s and 1990s are surviving into adolescence and adulthood, due to the availability of highly active antiretroviral therapy (HAART). Growing up with a chronic and stigmatized disease presents considerable challenges as young people explore their sexuality, develop relationships, and take steps to become independent and productive adults. Adherence to HAART is an essential and life-long practice for the maintenance of health and longevity. For adolescents born with HIV, a daily medication schedule is one aspect of disease management that also includes medical visits, HIV status acceptance, bouts of illness, and disclosure of HIV status to others. This research uses a framework of medical ecology to explore the personal, socio-familial, and medical contexts in which perinatally HIV-infected adolescents, as competent social actors, navigate the complexities of HIV disease management. It examines personal behaviors and attitudes, family dynamics, peer relationships, and health care structures and relationships that affect their adherence to HAART. A key finding of this study was increased agency and adaptation to HIV among adolescents who learned their diagnosis earlier in life and whose caregivers demonstrated acceptance of HIV and support for the adolescents. They were able to adhere to their medication regimens, despite busy schedules, non-disclosure to friends, and treatment fatigue, and also had a somewhat better understanding of the medical aspects of HIV and HAART. Yet all of the adolescents had gaps in their understanding of clinical indicators and viral resistance, and the relationship between adherence and HIV transmission. This deficit in a medical conceptualization and understanding of HIV and its ramifications is another important finding of this study. The adolescents' notions and actions regarding HIV disease, based on social, cultural, and medical norms and interactions within their environment, have a significant impact on the natural history of HIV. The level and consequent infectiousness of HIV as it responds to medications, mutates in their absence, and multiplies or is suppressed, depends on the individual's strict adherence to medications and attention to medical details, and affects HIV transmission to the individual's sexual partners. From both an individual medical and a public health perspective, an understanding of the ramifications of adherence and non-adherence to HAART is crucial. Early acceptance and understanding of HIV increase the possibility of successful medication adherence and overall disease management. In order to facilitate perinatally-infected adolescents' disease management and adherence to medications, it is recommended that the process of disclosure of HIV diagnosis to the child begin early so that the child is fully aware by the age of ten. The acceptance of HIV in the family and clear-cut roles and responsibilities for disease management should be facilitated by ongoing instruction and counseling. Adolescents should be given thorough, if basic, instruction on the medical aspects of HIV, and should be encouraged to have friends, and especially sexual partners, accompany them to their clinic visits. This will encourage greater understanding of HIV and perhaps lead to less stigmatization of HIV and those living with HIV. Finally, providers and adolescent patients should construct a partnership in which their individual models of disease management are integrated and power and responsibility are appropriately shared.
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ABSTRACT: Disclosure of serostatus is critical in preventing the transmission of HIV among youth. The purpose of this exploratory study was to describe serostatus disclosure in a multisite study of youth living with HIV. This study investigated serostatus disclosure and its relationship to unprotected sex among 146 youth participating in a multisite study of young people living with HIV who were sexually active within the past 3 months. Forty percent of participants reported a sexual relationship with a partner to whom they had not disclosed their serostatus. Participants with multiple sexual partners were less likely to disclose their serostatus than those with one partner. Disclosure was more frequent when the serostatus of the sexual partner was known. Disclosure was not associated with unprotected sex. Prevention initiatives should focus on both disclosure and condom use in this high-risk population, particularly for youth with multiple sexual partners.Journal of Adolescent Health 03/2012; 50(3):315-7. DOI:10.1016/j.jadohealth.2011.06.003 · 2.75 Impact Factor
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ABSTRACT: Abstract Adherence to antiretroviral medication for the treatment of HIV is a significant predictor of virologic suppression and is associated with dramatic reductions in mortality and morbidity and other improved clinical outcomes for pediatric patient populations. Effective strategies for addressing adherence problems in youth infected with HIV are needed and require significant attention to the complex interplay of multiple, interacting causal risk factors that lead to poor self-care. Within the context of a pilot randomized trial, we evaluated the feasibility and initial efficacy of a multisystemic therapy (MST) intervention adapted to address HIV medication adherence problems against a usual care condition that was bolstered with a single session of motivational interviewing (MI). For 34 participating youth, health outcomes (viral load [VL] and CD4 count) were obtained from approximately 10 months pre-baseline through approximately 6 months post-baseline and self-reported medication adherence outcomes were obtained quarterly from baseline through 9 months post-baseline. Using mixed-effects regression models we examined within- and between-groups differences in the slopes of these outcomes. Feasibility was supported, with a 77% recruitment rate and near-maximal treatment and research retention and completion rates. Initial efficacy also was supported, with the MST condition but not the MI condition demonstrating statistically and clinically significant VL reductions following the start of treatment. There was also some support for improved CD4 count and self-reported medication adherence for the MST but not the MI condition. MST was successfully adapted to improve the health outcomes of youth poorly adherent to antiretroviral medications. Replication trials and studies designed to identify the mechanisms of action are important next steps.AIDS Care 08/2012; 25(4). DOI:10.1080/09540121.2012.715134 · 1.60 Impact Factor