Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda

Abstract

BackgroundAdolescents have gained increased attention because they are the only age group where HIV related mortality is going up. We set out to describe the level and factors associated with adherence to antiretroviral therapy (ART) as well as the 1 year retention in care among adolescents in 10 representative districts in Uganda. In addition, we explored the barriers and facilitators of adherence to ART among adolescents.MethodsThe study involved 30 health facilities from 10 representative districts in Uganda. We employed both qualitative and quantitative data collection methods in convergent design. The former involved Focus group discussions with adolescents living with HIV, Key informant interviews with various stakeholders and in depth interviews with adolescents. The quantitative involved using retrospective records review to extract the last recorded adherence level from all adolescents who were active in HIV care. Factors associated with adherence were extracted from the ART cards. For the 1 year retention in care, we searched the hospital records of all adolescents in the 30 facilities who had started ART 1 year before the study to find out how many were still in care.ResultsOut of 1824 adolescents who were active on ART, 90.4 % (N = 1588) had ≥95 % adherence recorded on their ART cards at their last clinic visit. Only location in rural health facilities was independently associated with poor adherence to ART (P = 0.008, OR 2.64 [1.28 5.43]). Of the 156 adolescents who started ART, 90 % (N = 141) were still active in care 1 year later.Stigma, discrimination and disclosure issues were the most outstanding of all barriers to adherence. Other barriers included poverty, fatigue, side effects, pill burden, depression among others. Facilitators of adherence mainly included peer support groups, counseling, supportive health care workers, short waiting time and provision of food and transport.ConclusionAdherence to ART was good among adolescents. Being in rural areas was associated with poor adherence to ART and 1 year retention in care was very good among adolescents who were newly started on ART. Stigma and disclosure issues continue to be the main barriers to adherence among adolescents.

Long-Term Antiretroviral Treatment Adherence in HIV-Infected Adolescents and Adults in Uganda: A Qualitative Study

“…As with previous studies, stigma was reported to impact on ART adherence especially among adolescents in boarding schools [20,23,37,38]. These findings corroborate other studies reporting the challenges faced by ALWHA in schools including discrimination from their peers and educators suggesting an increasing need for sensitization and training on their rights and special needs in school settings [23,38].…”

“…The pivotal role of health-care providers and the clinic environment to ALWHA is well known, with various studies showing the need for supportive early disclosure to caretakers [42–44], provision of adolescent friendly services [45], role of peer groups [20,45,46] and support for gradual transition to adult based care [45,46]. Despite this information, lack of clear guidelines and support was associated to late, incomplete and poor disclosures by caretakers and the subsequent decline in adherence [42].…”

“…Few studies have assessed long-term adherence among adolescents and young adults in sub-Saharan Africa [16,17,20–23]. A recent study in Uganda reported stigma, discrimination, attending rural health facilities and disclosure issues as main barriers to adherence [20].…”

“…A recent study in Uganda reported stigma, discrimination, attending rural health facilities and disclosure issues as main barriers to adherence [20]. Peer support groups, counseling, supportive health care workers, short waiting time, provision of food and transport were facilitators.…”

Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

“…Relatedly, it is well documented that stigma is a key reason why adolescents do not want to disclose HIV status to their peers, as adolescence is a time when positive self-image and acceptance are some of the biggest considerations as adolescents build their network of peers and find their footing in the community [22]. As Suubi + Adherence is a combination intervention that integrates matched savings, financial education, and life skills for adolescents receiving the treatment, it is possible that participation in these program components provided ALWHA exposure to other adolescents with the same status and life circumstances, promoting confidence and alleviating perceived stigma on ART usage.…”