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Childhood Sexual Trauma and Antiretroviral Therapy Adherence: A Mixed-Methods Systematic Review

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Abstract

Childhood sexual abuse (CSA) has been shown to be more prevalent among populations living with HIV. Antiretroviral therapy (ART) adherence is crucial for populations living with HIV as it significantly increases the likelihood of attaining and maintaining viral suppression. Previous findings on the association between CSA and ART adherence have been mixed. The current mixed-methods systematic review aimed to identify quantitative and qualitative studies from CINAHL, PsycInfo, PubMed, and Web of Science examining the relationship between CSA and ART adherence. Authors were also contacted if relevant data were unpublished. Studies had to be published from January 1, 2000 to April 1, 2019, written in English, and examined CSA as an exposure and ART adherence as an outcome. Four domains were combined: (1) childhood sexual abuse; (2) child; (3) antiretroviral; and (4) adherence. Eight quantitative and two qualitative studies were retained. The results showed that four quantitative studies found no association while the other four found factors such as timing of victimization, mental health and gender influenced the association between CSA and ART adherence. Themes emerging from the qualitative studies included use of ART evoking memories of CSA; CSA impacting mental health; and mental health treatment improving ART adherence. Mixed insights included the intricate links between CSA and ART adherence and the role of external factors on the relationship. ART adherence intervention programs may be needed for people who have experienced CSA. However, future studies are needed that will examine the association between CSA and ART adherence and include subgroup analyses.

Resumen

El abuso sexual infantil es más prevalente en personas con VIH. La adherencia a la terapia antirretroviral (TAR) es crucial para personas con VIH porque incrementa la probabilidad de alcanzar y mantener la supresión viral. Resultados previos de la asociación entre el abuso sexual infantil y la adherencia a la TAR han sido variados. El objetivo de esta revisión sistemática utilizando métodos mixtos fue identificar investigaciones cuantitativas y cualitativas en CINAHL, PsycInfo, PubMed y Web of Science que exploran la relación entre el abuso sexual infantil y la adherencia a la TAR. Contactamos a los autores si no se publicaron datos relevantes. Las investigaciones tuvieron que ser publicadas desde enero 1 de 2000 hasta abril 1 de 2019, escritas en inglés, y explorando el abuso sexual infantil como la exposición y la adherencia a la TAR como el resultado. Cuatro ámbitos fueron combinados: 1) el abuso sexual infantil; 2) el niño; 3) el antirretroviral; y 4) la adherencia. Ocho estudios cuantitativos y dos estudios cualitativos fueron retenidos. Los resultados demostraron que cuatro estudios cuantitativos no mostraron asociación mientras los otros cuatros mostraron que los factores como el momento de victimización, la salud mental y el género influyeron en la asociación entre el abuso sexual infantil y la adherencia a la TAR. Los temas emergentes de los estudios cualitativos incluyeron el uso de la TAR que evoca recuerdos del abuso sexual infantil; el abuso sexual infantil tiene un impacto en la salud mental; y el tratamiento de salud mental mejora la adherencia a la TAR. Ideas mixtas incluyeron las relaciones complejas entre el abuso sexual infantil y la adherencia a la TAR, y el papel de los factores externos en la relación. Los programas de intervención para la adherencia a la TAR, tal vez, son necesitados para las personas que tuvieron la experiencia del abuso infantil. Sin embargo, se necesitan investigaciones futuras que examinen la asociación entre el abuso sexual infantil y la adherencia a la TAR incluyendo análisis de subgrupos.

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Acknowledgements

We would like to thank Dr. Myriam Torres for editing the Spanish version of the abstract.

Funding

This study was supported by the National Institute of Mental Health (NIMH) under Award Number K01MH115794 (MJB) and was made possible in part by Grant Number T32-GM081740 from the National Institute of General Medical Sciences, both of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Monique J. Brown & Andrea D. Brown

  2. South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Monique J. Brown & Xiaoming Li

  3. Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Monique J. Brown & Elizabeth Crouch

  4. Office for the Study on Aging, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Monique J. Brown

  5. Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA

    Mohammad Rifat Haider

  6. Thomas Cooper Library, University of South Carolina, Columbia, SC, USA

    Amy Edwards

  7. Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Elizabeth Crouch

  8. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA

    Xiaoming Li

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Brown, M.J., Brown, A.D., Haider, M.R. et al. Childhood Sexual Trauma and Antiretroviral Therapy Adherence: A Mixed-Methods Systematic Review. AIDS Behav 25, 475–491 (2021). https://doi.org/10.1007/s10461-020-03009-7

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