Lower Optimal Treatment Adherence Among Youth Living With HIV in a Universal Health Care Setting Where ART Is Available at No Cost

Abstract

PurposeWe assessed differences in optimal adherence between youth (aged 15–29 years) and adults (aged ≥30 years) enrolled in the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Program from 2010 to 2016. MethodsPopulation-level clinical data were used to compare optimal antiretroviral therapy adherence (≥95%), based on pharmacy refill data, among youth and adults. Unadjusted and adjusted generalized estimating estimates were performed to examine the independent relationship between time-dependent age categories and optimal adherence, adjusting for confounders. Factors associated with optimal adherence among youth were examined. ResultsData for 7,485 individuals living with HIV were included. Median follow-up was 7 years (Q1–Q3: 4–7). Over the study period, the number of individuals categorized as "youth" ranged from 820 in 2010 to 291 in 2016. Multivariable models found youth living with HIV were significantly less likely to be optimally adherent than adults (adjusted odds ratio [aOR] = .55; 95% confidence interval [CI]: .49–.62), after controlling for potential confounders, although youth adherence improved significantly during the study period. Among youth, increasing time-dependent age (aOR = 1.18/year older; 95%CI: 1.11–1.25) and number of years on antiretroviral therapy (aOR = 1.15, 95%CI: 1.10–1.19) were independently associated with optimal adherence, while Hepatitis C-positive serostatus (aOR = .55; 95%CI: .33–.92) and multiple treatment regimen change (aOR = .89/regimen change; 95%CI: .81–.97) were negatively associated with optimal adherence. ConclusionsYouth were less likely to be optimally adherent throughout the study period. Findings suggest implications for increased youth-centered adherence support, particularly for youth living with HIV concurrently living with Hepatitis C, newly initiating treatment, and going through medication change.