High self‐reported non‐adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors

Abstract

Introduction: Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV-related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self-reported ART adherence, barriers to adherence, and factors associated with non-adherence amongst ALHIV in Malawi.Methods: Cross-sectional study of 519 ALHIV (12–18 years) attending two large HIV clinics in central and south-eastern Malawi. Participants self-reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self-reported ART adherence (7 day recall).Results: The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41–17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43–3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08–3.21]), and poor treatment self-efficacy (OR 1.55 95% CI [1.02–2.34]). Sex and age were not associated with adherence.Conclusions: In our study, nearly half of all ALHIV reported non-adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self-efficacy were associated with worse adherence. Sub-optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.

Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV-Infected Adolescents at Pediatric Department of Yopougon University Hospital, Côte d’Ivoire

“…This result was also found in a study conducted in Zambia among 15 -19-years old adolescents [20]. However, other studies have shown no significant difference between girls and boys [21]. This difference in the rate of non-adherence to ART between girls and boys HIV infected varies from one region to another.…”

Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent‐centred differentiated care model compared with standard of care: a nested case–control study at a tertiary referral hospital in Malawi

“…Médecins sans Frontières has also piloted a Youth Clubs program in Cape Town, including a structured interactive activity‐based session rooted in peer support that has been endorsed in the South African national adherence policy. Few interventions, however, have been described in the peer‐reviewed literature and evaluations have not looked at retention in care as an outcome . This is one of the first studies to date to look at the impact of an adolescent focused differentiated model of care on ART retention.…”

“…Further qualitative research in particular around the barriers associated with retention in care, non‐adherence, the effect on Teen Club programming on these barriers, and disentangling the individual factors that may prompt ALHIV to choose standard of care versus Teen Club, would be valuable in evidence‐informed program modification. A recent cross sectional study of a representative sample of ALHIV in the ZCH clinic and another large tertiary referral clinic in Malawi, looked at barriers and associated factors to self‐reported non‐adherence and found the most commonly reported barriers to adherence included forgetting (>90%), travel from home (14%), and “busy doing other things” (11%). Drinking alcohol in the past month, witnessing or experiencing violence in the home in the past year, and poor treatment self‐efficacy were each found to be independently associated with missing ART in the past week.…”

Pesky metrics: the challenges of measuring ART adherence among HIV-positive adolescents in South Africa

“…Public access to ART within hyper-endemic and resource-constrained settings has allowed for a more sustained focus on the practicable and experiential challenges of adolescent ART adherence within an array of settings (Merten et al, 2010;Sahay, Reddy, & Dhayarkar, 2011). A number of recent studies on adherence have sought to confront challenges of representativeness through locating research within multiple sites, providing potential for comparison across different locations and adolescent populations (Bernays et al, 2017;Kim et al, 2017;Nabukeera-Barungi et al, 2015). As an adjunct to research focusing on the clinical efficacy of ART, studies on ART adherence have included components on the socio-behavioural factors of adherence.…”