Abstract
BackgroundAdolescents living with HIV face substandard outcomes along the continuum of care, including higher rates of poor adherence and virologic failure. Support groups have been identified as a method to improve adherence, but there is insufficient evidence regarding their effectiveness. This study seeks to examine the protective influences for and barriers to antiretroviral therapy (ART) adherence in HIV-positive adolescents living in Tanzania.MethodsThis is a qualitative study conducted in Tanzania from January to March 2018. The sample of adolescents aged 10-19 (n = 33) was purposefully selected based on age, gender, and support group attendance to capture a broad range of experiences. Participants completed an in-depth interview, covering topics such as retention in HIV services, support group experiences, and joys and challenges of adolescent life. Interviews were coded and themes related to ART adherence were identified and summarized.ResultsSupport groups helped promote adherence by improving adolescents’ knowledge and confidence. Participants associated joining support groups with an improvement in health. Almost every participant described the significant positive influence a treatment supporter had on adherence. Adolescents’ daily schedules and emotional state served as a barrier to adherence. Furthermore, adherence was negatively impacted by participants’ fear of accidental disclosure.ConclusionLogistical and psychosocial factors can hinder adherence. Interventions that provide both education and psychosocial support, such as peer support groups, have the potential to improve health outcomes for this population, but may not address more persistent barriers to adherence rooted in lack of treatment support from family members or friends who have not been disclosed to, or lack of transportation funds/food security.
Highlights
Adolescents living with HIV face substandard outcomes along the continuum of care, including higher rates of poor adherence and virologic failure
The analysis presented here focuses on the themes related to antiretroviral therapy (ART) adherence identified through the interviews related to adherence facilitators and barriers, including adolescent support groups
A number of themes related to ART adherence, including adherence facilitators and barriers were identified through the interviews (Table 1)
Summary
Adolescents living with HIV face substandard outcomes along the continuum of care, including higher rates of poor adherence and virologic failure. As of 2020, from 25 to 80% of adolescents with HIV in sub-Saharan African focus countries were not on antiretroviral therapy (ART) and adolescents have lower viral suppression rates compared to adults [3], and HIV-positive adolescents have demonstrated higher rates of poor adherence and virologic failure than children or adults [2, 5,6,7,8,9,10]. Adolescents living with HIV contend with complex psychosocial factors, as well as gaps in knowledge about HIV and its prevention. This population has been found to exhibit increased rates of mental health problems, including depression and suicide attempts, which have been associated with incomplete adherence [13, 14]. Disparities in knowledge about HIV prevention have been associated with difference in gender, education, household wealth, and place of residence [2]
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