Meet the CIPHER grantees

Millicent Atujuna

Year awarded: 2018
Institution: Desmond Tutu HIV Centre/Foundation (DTHC/F)
Research site: Gugulethu Community Health Centre, Cape Town, South Africa
Primary mentor: Linda-Gail Bekker

Millicent Atujuna is a social behavioural scientist and division head at the Desmond Tutu HIV Foundation in Cape Town. Her current interests are on designing differentiated models of care that will improve both ART uptake and translate into HIV prevention. She is currently running a project aimed at transitioning adolescents on HAART from paediatric to adult HIV care.

More information on Millicent | Email

“Receiving the CIPHER grant means that I can finally scientifically explore the ideas that I have built over time, and working with youth, generate evidence research that will generate meaningful interventions that will make a difference to many youth in low social economic settings.”

Research project: The impact of poverty on anti-retroviral therapy adherence and retention in care of South Africa’s generation of adolescents living with HIV: Implications for strategies and intervention development

The issue

Poor ART adherence among adolescents living with HIV is well documented, with factors well articulated. Among them are stigma, problems with disclosure, treatment fatigue, stress and depression, forgetting to take pills, lack of familial support and poor healthcare infrastructure. There is, however, a dearth of evidence in current research disaggregating the impact of poverty on adolescents’ ability to adhere to ART in South Africa, a country where 54% of the total population lives below the poverty line of $2 per capita per day.

Over the years, Dr Atujuna has noted that most current youth programmes in low socio-economic settings are based on or adapted from interventions in countries that are socially, culturally and economically different from these contexts. She would like to close that gap. Her contention is that besides challenges experienced in this critical phase of development, adolescents whose families experience poverty and other difficult social circumstances are unlikely to adhere to ART. “We need interventions that target this key population and ensure that we improve treatment adherence, which eventually leads to reduced HIV incidences at population level,” she says.

The CIPHER project

This study will investigate the link between poverty and ART adherence and retention in care among youth aged 14-24 years. A mixed-methods study design is proposed. Data will be sourced from:

  • Clinic databases and files in order to classify adherent, non-adherent and lost to follow up for a cohort of adolescents at the one of the ART clinics in Gugulethu, Cape Town
  • A tablet-based survey that isolates the role of poverty ART adherence
  • A series of in-depth interviews with adolescents and their caregivers
  • Familial case studies in order to generate a comprehensive understanding of the impact of poverty on adolescents’ ability to adhere to ART.

The impact

The results will be used to identify strategies to improve adolescent adherence and retention in care.