Abstract
Lower levels of adherence to antiretroviral therapy (ART) among older adolescents as compared to adults are influenced by individual, psychosocial, and treatment-related factors. Successful transition of older adolescents into HIV adult care from paediatric & adolescent focused care requires an understanding of barriers to ART adherence. This study aimed at determining individual factors affecting ART adherence among older HIV positive adolescents transitioning to adult care. Between December 2018 and January 2019, we conducted a cross-sectional study among 82 perinatally infected adolescents aged 16-19 years in an HIV care and treatment clinic in Nairobi, Kenya. We used completed structured questionnaires and abstracted data from clinical charts. We performed multivariate logistic regression to identify factors independently associated >95% self-reported ART adherence (7-day recall). The study participants had a median age of 17 (IQR 16,18) on ART for a median duration of 11 years (IQR 7,13). Sixty-four per cent (52) of the adolescents reported optimal adherence was of >95%, and 15% reported missing doses for three or more months. Self -reported adherence had a high correlation with viral loads of <1000 copies ml (Kappa= 0.087). Adolescents with high self-efficacy were eight times more likely to report adherence of >95% [OR 8.1, 95% CI (2.31- 28.18)]. Once a day, dosing was also independently associated with adherence [OR 1.58, 95 %CI [0.62-4.08]. The reduction of ART pill burden and the inclusion of assessment of ART self -efficacy may contribute to transition preparedness among adolescents.
Highlights
There are approximately 1.3 million adolescents (10-19 years) living with HIV (ALWHIV) in Eastern and Southern Africa (1) and nearly 300,000 adolescents and young adults (15-25 years) are living with HIV in Kenya majority of whom acquired HIV during the perinatal period (UNAIDS, 2016)
To achieve the UN Joint Programme on HIV/AIDS (UNAIDS) goal of ensuring 95% of people living with HIV (PLWHIV) achieve viral suppression, older adolescents must remain motivated to continue adherence to antiretroviral therapy (ART) as they gain independence and begin to practice self-management
This study aimed at determining the individual-level, socio-demographic, clinical and psychosocial factors affecting adherence to ART among older HIV positive adolescents transitioning to adult care
Summary
There are approximately 1.3 million adolescents (10-19 years) living with HIV (ALWHIV) in Eastern and Southern Africa (1) and nearly 300,000 adolescents and young adults (15-25 years) are living with HIV in Kenya majority of whom acquired HIV during the perinatal period (UNAIDS, 2016). To achieve the UNAIDS goal of ensuring 95% of people living with HIV (PLWHIV) achieve viral suppression, older adolescents must remain motivated to continue adherence to ART as they gain independence and begin to practice self-management (UNAIDS, Nations, & UN Joint Programme on HIV/AIDS (UNAIDS) 2014). Viral suppression, retention to care and adherence to antiretroviral therapy (ART) among older adolescents (15-19 years) is lower than that of adults and children (Lamb et al, 2014) (Carrizosa et al, 2014). A successful transition of the adolescent to adult care (defined as „the purposeful, planned movement of adolescents and young adults with chronic physical and medical conditions from child‐centred to adult‐oriented health care systems) (Carrizosa et al, 2014) often means that the adolescents must possess the motivation to continue to adhere to lifelong ART
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