Abstract:
Background; Antiretroviral treatment requires high-level (> 95%)
adherence for optimal viral suppression. Published data on
adherence to antiretroviral (ARVs) in Kenyan adolescents is very
limited. The purpose of this study was to establish the prevalence of
ARVS adherence among HIV positive adolescents at
Comprehensive Care Centre, Gertrudes’ Children Hospital.
Methods; This was a facility-based descriptive cross-sectional
study, where 185 patients aged 10-18 years who had been on ARVs
for at least two years were systematically and randomly selected.
Among them, 129 respondents who were HIV fully disclosed were
interviewed using a structured questionnaire about their experience
taking ARVs. Adherence was measured based on a composite score
derived from a three questions adherence tool developed by Center
for Adherence Support Evaluation (CASE). Data was also collected
from records retrieval. Data analysis was done using Epi data
software 3.1 with statistical significance set at p<0.05; Statistical
analysis of Frequencies, correlations, ANOVA and multivariate
logistic regression to test for predictors of adherence. Results;
Overall, 185 patients were selected but 129 disclosed patients were
interviewed; 52.7% males and 47.3% females, estimated level of
adherence of 67.34% and the main (63.6%) reason for missing
therapy was forgetting. Long waiting time in the clinic and
stigmatization were other factors found to affect adherence. The
CASE Index Tool depicted high reliability with a Cronbach’s
α=0.696. The results showed a significant positive correlation
between CD4 counts and adherence (Rh0=0.255, p=0.003) and a
significant inverse correlation between Viral Load levels and
Adherence (Rh0= -0.189, p=0.031). There was no significant
association between HIV disclosure and ARVs adherence.
Conclusion and recommendations; The 67.34% adherence level to
ART reported in this study is below optimum adherence of 95%.
This study gives the following recommendations; (a) Policy review
on HIV disclosure procedures with training of health workers on it
(b) Put fitting strategies to improve patients’ ability to impact on
forgetfulness (c) Clinic staff to adopt the use of CASE Tool in
assessing adolescent’s adherence to ARVs.
