Antiretroviral therapy adherence and its determinants among adolescents in Kajiado county, Kenya

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.