Adherence to Highly Active Antiretroviral Therapy and Associated Factors Among HIV Positive Adolescents in Muranga County Hospital, Kenya

Abstract

The introduction of Highly Active Antiretroviral Therapy (HAART) in the management of HIV infection has led to a significant decline in HIV-related morbidity and mortality. This chronic condition has now become a manageable disease. However, the treatment outcomes may get hindered by suboptimal adherence to ART. The fact that a nearly perfect adherence is required in HAART has remained a major task to people living with HIV (PLWHIV). HIV treatment extends beyond knowledge advancement among PLHIV as strong collaboration between them and healthcare providers is required, with the HIV-infected person assuming the chief responsibility of self-care that will result in adherence and a good clinical outcome. Adolescent HIV/AIDS epidemic needs to be handled and followed keenly as they face problems in accepting their HIV status, undergo behavioural experimentation, identity formation, face difficult choices on sexual behaviour,alcohol and recreational drugs. They also face a big question mark in their future regarding health, education, carrier development and their social life. With all these challenges they are at high risk of having low adherence to HAART as compared to children and adults. This descriptive cross sectional study sought to assess the proportion of adolescents adhering to HAART and identify individual and health system factors associated with adherence at Murang’a County Hospital Comprehensive Care Center. A total of 85 adolescents were consecutively interviewed during their clinal visitsat the CCC. Interviews were conducted using an interviewer-administered semi-structured questionnaire. Ethical approval was sought from Kenyatta National Hospital-University of Nairobi Ethical Review Committee. Quantitative data from questionnaires was entered and analysed using IBM SPSS 22.0. The findings were presented in form of narratives, tables, charts and graphs. The study found 75% of the adolescent adhered to HAART with 24.7% being non-adherent (95% confidence interval (CI) 16.8% to 34.8%). Individual factors such as having supportive parents or care givers, disclosure of HIV status at early stage and being in a day school was associated with HAART adherence whereas early (10-13yrs) and mid (14-17yrs) adolescence, being a student in a boarding school, alcohol and other substance abuse (OR 10.500 (95% CI 1.157-95.254), p = 0.024) was associated with HAART non adherence. Health system factors such as lower pill burden(1 or 2 pills daily) was associated with 87% lower odds of being non-adherent to ART (OR 0.127 (95% CI 0.027-0.591), p = 0.003), having caring and listen health providers was found to have about 80% lower odds of having ever missed their medications (odds ratio (OR) 0.212 (95% CI 0.057-0.789), p=0.023),convenient clinic working hours and having age specific psychosocial support groups were also associated with HAART adherence whereas very far distances from the health facility was associated with HAART non adherence. This study found that a notable proportion of self-reported suboptimal ART adherence among adolescent living with HIV,this is likely to place this cohort at an increased risk of HAART failure, disease progression as well as increased risk of HIV transmission and increased mortality.Based on the findings of this study,there is need to design strategies to address the barriers to HAART adherence in adolescent. The study indicates an urgent need for interventions that will assist adolescent HAART adherence, strategies to support early disclosure, psychological support by the caregivers both at home and school will address some of the individual factors hindering adherence.