Childhood trauma exposure and adherence to antiretroviral therapy (ART) among patients attending a public neuropsychiatry health facility
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Date
2020
Authors
Miseer, Prinesh
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Abstract
Background: Despite the latest efforts and guidelines to ensure access to Anti-retroviral (ART) treatment for HIV, South Africa still faces public health concerns with regards to the spread of HIV and adherence to treatment. Due to many factors, South Africans have been exposed to multiple traumas throughout their lives, especially childhood trauma. The study tried to determine the possible association between childhood trauma and adherence to Anti-retroviral treatment. Methods: Data was collected from Luthando clinic, a public neuropsychiatric facility in Johannesburg, specialising in the treatment of patients with HIV and mental illness. Patients attending the clinic between: June 2017 to December 2017, on ARTs for 2 years and older than 18 years of age were included in the study. Their files were retrospectively reviewed for a history of childhood trauma, number of traumatic events and age of first childhood trauma, demographics collected, psychiatric diagnosis noted, ART regimen and CD4 count and viral load parameters recorded. Two consecutive viral loads were used to determine adherence to HIV treatment. The Chi square test, Fisher’s exact test was used to determine the relationship between categorical study variables and a history of childhood trauma, with the strength of associations measured by Cramer’s V and phi co – efficient respectively. The relationship between continuous study variables and childhood trauma was assessed by the independent samples t – test and Wilcoxon rank sum test, and associations measured with the Cohen’s d (parametric tests) and r – value (non – parametric tests).Results: A sample of 150 subjects was included in the statistical analysis. 31.3% (n = 47) of subjects experienced childhood trauma. Non – adherence to ARTs and childhood trauma exposure revealed no significant association. Significant associations that were found included a greater proportion of females exposed to childhood trauma compared to females who hadn’t experienced childhood trauma (p – value = 0.0096) and a significantly higher ratio of females to males who had experienced childhood trauma. Another significant finding was lower adherence in subjects using 2nd line ART regimen compared to 1st line ART regimen (p – value = 0.0042).Conclusions: Childhood trauma remains a concern in public health in South Africa. Female childhood trauma exposure remains high and warrants further research in order to find solutions to decrease this problem. Whilst no significant association was found between childhood trauma exposure and non – adherence to ART, further research would be required to establish other variables that could affect non- adherence to ART. Clinics such as Luthando may be used as a model to increase adherence to ART in other clinics.
Description
A research report submitted in partial fulfillment of the requirements for the degree of
Master of Medicine (MMed) (Psychiatry) to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020