Violence Victimization and HIV Care and Treatment Practices among Youth Living with HIV in Zambia

Johns Hopkins University, Baltimore MD

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Abstract

PROJECT SUMMARY/ABSTRACT Background. Virtually no data exist on violence victimization and its relationship to HIV care and treatment practices among HIV-positive youth ages 15-24 in sub-Saharan Africa (SSA). SSA, however, has some of the world?s highest HIV and gender-based violence prevalence rates and is home to 80% of the world?s HIV-positive youth. Understanding whether and how youth?s violence victimization affects their engagement with the HIV care continuum will further our ability to address the HIV epidemic among vulnerable youth in SSA. Study Goal and Aims. This study will examine violence victimization and HIV care and treatment practices among youth living with HIV (YLHIV) ages 15-24 in Ndola, Zambia. Specific aims are to: 1) estimate the prevalence and perpetrators of physical, emotional, and sexual violence against YLHIV; 2) examine associations between past-year violence victimization and viral load suppression among YLHIV; and 3) qualitatively explore mechanisms through which violence victimization influences youth?s engagement in HIV care and treatment. Approach. This explanatory, sequential mixed-methods study will leverage the data and infrastructure of an existing parent study that is an individually-randomized controlled trial assessing the impact of a 6-month peer- mentoring intervention on HIV outcomes among HIV-positive youth. Aims 1 and 2 will be secondary analyses of baseline data collected by the parent study from 288 youth, systematically recruited from four clinics and evenly distributed by sex. Aim 1 will use internationally-recognized measures to identify the prevalence and perpetrators of lifetime and past-year physical, emotional, and sexual violence against YLHIV. Aim 2 will employ regression techniques to quantify associations between youth?s past-year violence victimization and viral load suppression, controlling for factors at multiple levels. Building on findings from Aims 1 and 2, Aim 3 will qualitatively explore the influence of violence victimization on youth?s engagement in HIV care and treatment (i.e. clinic visits, medication adherence) by conducting about 40 in-depth interviews with youth participants from the parent study. Findings will be triangulated to develop a more nuanced understanding of this important topic. Fellowship Information. The proposed research will serve as the doctoral dissertation of Ms. Katherine Merrill, a PhD student at Johns Hopkins Bloomberg School of Public Health. The training is guided by one Sponsor, two Co-sponsors, one Scientific Advisor, and one Statistical Advisor with complementary methodological and topical expertise, including expertise in violence research and clinical care. The training plan combines formal coursework, ongoing mentorship, field research, and other opportunities to prepare Ms. Merrill to become a leading independent researcher on the intersection between HIV and violence in low-resource settings globally. The proposed study directly aligns with the NIH FY 2017 research priorities of understanding factors that influence HIV treatment strategies and improving engagement and retention in care.