Abstract:
Background: Anti-Retroviral Therapy (ART) use has increased globally. It is
estimated that 15M (41%) People Living with Human Immunodeficiency Virus
(PLHIV) are receiving ART, out of which 823,000 are children. Adherence to ART
influences viral load reduction, improved immunity and treatment success. Studies
show an almost 100% adherence is needed to sufficiently suppress viral replication.
However, several factors hinder adherence success including; poverty, substance
abuse, stigma and lack of disclosure. While HIV prevalence has continued to decrease
worldwide, it remains a major cause of morbidity and mortality among adolescents.
Poor ART adherence increases the risk of viral drug-resistance, reduces future
therapeutic options and increases the risk of transmission. Adherence has been studied
extensively with adult patients, but adolescent adherence has been largely neglected in
the literature.
Objective: The aim of this study was to estimate prevalence of ART adherence and to
identify characteristics of adolescents and their guardians that influence ART
adherence
Methods: A cross sectional, facility-based study was carried out in four select
facilities in Kajiado County. Qualitative and quantitative data was collected among
HIV positive adolescents and their guardians. Simple Random Sampling without
replacement was used to identify participants. A sample size of 174 was arrived at
using the Cochrane formula. All eligible adolescent had an equal opportunity to
participate. Data was managed using Statistical Package for the Social Sciences.
Proportions and frequencies were calculated for categorical data and means and
medians for continuous variables. Bivariate analysis was conducted to estimate
strength and direction of associations between factors using a 95% confidence
intervals and P-value (<0.05). To determine and control for multiple independent risk
factors, logistic regression was performed for factors with a p-value of < 0.05. Ethical
clearance was sought from Moi Institutional Research and Ethics Committee.
Results: A total of 167 adolescents aged 10-19 were interviewed. Males constituted
49% and Females 51%. Estimated level of adherence was 92.8% (95% CI 87.8% -
95.8%). At bivariate analysis, significant factors at P-value (<0.05) were occupation
(P= 0.021), side effects (P= 0.009), lack of food(P= 0.013), having friends(P=
0.011), confidentiality(P= 0.003), trust(P= 0.009) and quality of care rating(P= 0.05),
swallowing drugs at the right time(P= 0.000) and keeping clinic appointments (P=
0.004). On multiple regression, two factors contributed significantly to the model,
experiencing side effects and having friends who knew the adolescent status and cared
for them F (4,157) =22.302 p<0.05. The most common reason for missing a dose was
forgetting, fear of stigma and lack of food
Conclusions: This study found a prevalence rate slightly lower than the optimum and
higher
than most studies. Medication related factors were the most significant predictors of
adherence
Recommendations: Adopt mechanisms to remind adolescents to take ART, improved
regimen with reduced side effects, psycho social support and stigma reduction
strategies.