Abstract
Human immunodeficiency virus (HIV) management of adolescents and young adults (AYAs) is particularly pertinent to sub-Saharan Africa, where the pediatric HIV burden is marked. Antiretroviral treatment (ART) adherence is a major challenge for AYAs. This qualitative study explored knowledge and experiences of adherence amongst AYAs attending treatment at the Perinatal HIV Research Unit (PHRU), Soweto, South Africa. Four focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with HIV-infected 15–25-year-old ART recipients. Transcripts were coded thematically. Participants (n = 26) were aged median 18.5 years, 59.1% female and 69.2% virally suppressed <400 cp/ml. Three main themes emerged during FGDs and IDIs: (i) correct knowledge about how to be adherent, benefits, and nonadherence consequences, (ii) social, personal, and medication-related barriers to adherence, and (iii) reminder, concealment, and motivational strategies to optimize adherence. Interventions to improve AYA adherence could focus on practical strategies, including status disclosure and medication concealment.
Highlights
The highest global burden of Human immunodeficiency virus (HIV) is in South Africa, where prevalence was 12.2% (6.4 million people) in 2012 [1]
A total of 18 participants participated in the focus group discussions (FGDs), 13 females (72.2%) and 5 males (22.8%)
AYAs may present with specific adherence problems, such as denial about HIV persistence after a childhood of treatment and the issues that HIV/AIDS poses to them during a phase of development in which social assimilation gains prominence in their lives
Summary
The highest global burden of HIV is in South Africa, where prevalence was 12.2% (6.4 million people) in 2012 [1]. Amongst AYAs aged 15 to 24 years, prevalence was 7.1% [1]. About two-thirds of infected AYAs in South Africa acquired the virus through vertical transmission [2]. Before South Africa implemented prevention of mother-to-child transmission interventions, an estimated 60.000 perinatal HIV infections occurred per annum [3]; since improved ART access has reduced this number drastically. In 2013 alone, there were still 16.000 new infections in the 0–14-year-old age group in South Africa [4]. With ART advances, these children can and do survive into adolescence and adulthood [5, 6]
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