Abstract
Children and adolescents with Perinatal Acquired HIV (PHIV) face many challenges to remain adherent to long-term Antiretroviral Therapy (ART). Among adolescents, adherence is often not static but changes over time due to the circumstances of the individual. The study assessed the ART adherence levels and patterns of adolescents with PHIV who were receiving long-term ART. This quantitative cross-sectional study was conducted in Mohale's Hoek, a rural Health District in Lesotho between May and December 2018. Adolescents aged 10-19 years who were aware of their HIV status were recruited from selected youth-friendly HIV clinics. Adherence was measured through a self-report of the last pills missed, based on 30 days recall. Stata version 13 was used for analysis. The sample consisted of 130 adolescents, 57% were females, the mean age was 15 years, the mean age of ART initiation was nine years, and the mean ART duration was four years. Self-reported adherence was very high at 92%, and 88% reported not delaying taking ART. Self-reported optimal ART adherence was achieved by 85% of the adolescents, 15% were non-adherent, and 92.3% had not missed clinic appointments in the past 30 days. Episodes of non-adherence among those who delayed taking ART on time occurred in the evenings, mornings, weekdays, and weekends. Non-adherence episodes for 59% occurred more in the evenings than other periods of the day. Conclusion: The results suggest that despite high self-reported adherence, adolescents take medication inconsistently and have situational adherence patterns. The dosing of medication and regimens should be flexible and take into consideration the context of the adolescents.
Highlights
With the success of Antiretroviral Therapy (ART), there has been an increasing number of children with Perinatal HIV (PHIV) who are maturing into adolescents and young adults [1]
While the WHO recommends that children be disclosed their HIV status by 10–12 years old, the mean age of enrolment in care of the adolescents in this study was 15 years, suggesting that they were unaware of their HIV status until late adolescence
We found that self-reported adherence was high; the optimal ART adherence (>95%) was achieved by 85% of the adolescents based on the 30 days recall of the last pills missed; only 15% reporting missing ART in the past month and were classified as non-adherent
Summary
With the success of Antiretroviral Therapy (ART), there has been an increasing number of children with Perinatal HIV (PHIV) who are maturing into adolescents and young adults [1]. Children and adolescents with PHIV are a growing population in sub-Saharan Africa [2]. Adherence to the ART regimen remains one of the important concerns when providing ART to children and adolescents with PHIV. This is important in resource-limited countries where second-and third-line regimens are not readily available and could eliminate children's limited treatment options [3,4]. Self-reported measures remain the most commonly used method to determine adherence in sub-Saharan Africa [6], the gold standard for assessment of treatment adherence is the viral load measurement [3]. The viral load measure is a cardinal marker of how well an individual is doing on ART and adherence to the ART regimen [7]
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