Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study

Abstract

BackgroundAround 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan Africa. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART adherence among children and teenagers in rural Tanzania.MethodsWe applied a sequential explanatory mixed method design targeting children and teenagers aged 2–19 years residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining focus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined optimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic regression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored issues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was analysed using thematic content analysis.ResultsOut of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the average adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the qualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity, being unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and forgetfulness were seen to be barriers for optimal adherence.ConclusionThe study has highlighted specific challenges in ART adherence faced by children and teenagers. Having a biological parent as a caretaker remains a key determinant of adherence among children and teenagers. To achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system need to be designed.

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

“…The use of treatment reminders was associated with better adherence while the use of PI-based regimens predicted poorer adherence. The adherence rate in the current study is better than those reported from several low, middle and high income countries (Bhattacharya & Dubey, 2011;Kim, Gerver, Fidler, & Ward, 2014;Nyogea et al, 2015;Reda & Biadgilign, 2012;Ugwu & Eneh, 2013). …”

Scaling a waterfall: a meta‐ethnography of adolescent progression through the stages of HIV care in sub‐Saharan Africa

“…Anticipated stigma (fears surrounding social exclusion) was common at the individual level, negatively influencing motivations to obtain an HIV diagnosis [39][40][41][42][43][44][45][46] and to follow up on test results [44,45]. This was reinforced by experiences with external stigma at other levels including: family neglect or ostracism from peers [39,40,43,[47][48][49][50], community gossip [41][42][43]46], discrimination in school [49,[51][52][53][54] or lack of empathy from health care workers (HCW) [45,50,[55][56][57]. Such social conditions reinforced barriers to HIV care linkage, retention in HIV services and adherence; with ALHIV often choosing to prioritize secrecy around their disease status over unintended disclosure [48,[51][52][53][54][55][57][58][59][60].…”

“…This was reinforced by experiences with external stigma at other levels including: family neglect or ostracism from peers [39,40,43,[47][48][49][50], community gossip [41][42][43]46], discrimination in school [49,[51][52][53][54] or lack of empathy from health care workers (HCW) [45,50,[55][56][57]. Such social conditions reinforced barriers to HIV care linkage, retention in HIV services and adherence; with ALHIV often choosing to prioritize secrecy around their disease status over unintended disclosure [48,[51][52][53][54][55][57][58][59][60]. This choice frequently accounted for missed ART doses when social conditions were unfavourable, such as having minimal privacy in the home [49,51,53,57] or at school [49,52].…”

“…Such social conditions reinforced barriers to HIV care linkage, retention in HIV services and adherence; with ALHIV often choosing to prioritize secrecy around their disease status over unintended disclosure [48,[51][52][53][54][55][57][58][59][60]. This choice frequently accounted for missed ART doses when social conditions were unfavourable, such as having minimal privacy in the home [49,51,53,57] or at school [49,52]. (7,8,9,10,11,12,13,14,16,18, Health awareness /knowing ones status (1,3,4,5,6,11,17,18,22,23) Frustration surrounding side effects (9,11,12,14,16,19,21) Drug fatigue (7,12,14,16,18) Forgetting (8,12,18) Frustration surrounding lack of independence /reactance (9,17,18) Morning dose problems (oversleeping, late) (12,18) Travelling /not being home /school trips interfere with medication routine…”

Adherence to Highly Active Antiretroviral Therapy Among Children in Ethiopia: A Systematic Review and Meta-analysis

“…Among these factors, some of them are unfavorable school environment, pills burden of the HIV drug, treatment longevity, being unaware of HIV status, non-parental care, preference for traditional medicine and forgetfulness [35–38]. …”