Resum

Adolescents and young adults living with HIV are situated within a dynamic confluence of behavioral, developmental, and care transitions that pose unique challenges to provide optimal healthcare. Depression and substance use may impact antiretroviral therapy (ART) adherence, but data from Latin America are scarce. We evaluated the prevalence and factors associated with depression, substance use, and self-reported adherence among youth in HIV care. Cross-sectional study including adolescents (10 to <18 years) and young adults (18 to <25 years) on ART for =6 months within the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) in Brazil, Chile, Haiti, Honduras, Mexico and Peru. Individuals were screened for depression (Patient Health Questionnaires,PHQ- 2/9/A), substance use (The Alcohol, Smoking and Substance Involvement Screening Test) and ART adherence (The Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol). Multivariable logistic regression models were used to evaluate factors associated with each outcome. Of 592 participants included in the analysis, 308 (52%) were female, 235 (40%) were 10-17 years old and 355 (60%) had undetectable viral load. The prevalence of depression was 16%. Regarding substance use in previous 3 months, 338 (57%) used alcohol, 170 (29%) tobacco, and 110 (19%) illicit drugs. Non-adherence in previous week was reported by 213 (36%) participants. Females were more likely to report depression (adjusted odds ratio (aOR) 2.9, 95% CI 1.65.1) and less likely to report illicit drug use (aOR 0.34, 95%CI 0.20.7) than males. Alcohol use in previous 3 months was associated with the use of tobacco (aOR 10.4, 95%CI 4.623.9) and illicit drugs (aOR6.9, 95%CI 1.826.4). Tobacco was the only substance associated with non-adherence (Table). The prevalence of substance use was higher than found among CCASAnet adults in a previous analysis. Youth reporting alcohol and tobacco use should be screened for illicit drug use. Although alcohol and illicit drugs were not associated with ART adherence, youth using these substances may be at increased risk for mortality related to violence and traffic accidents - which are the main cause of death in many Latin American countries. Further studies and interventions are needed.