Factors associated with adherence to Anti-Retroviral Therapy (ART) among adolescents attending HIV clinic at China-Uganda Friendship Hospital-Naguru, Uganda

Abstract

Background: AIDS is the leading cause of death among adolescents in Africa. Poor adherence reduces the effectiveness of ART and has aggravated virological failure among Adolescents living with HIV infection (ALWHIV) at China-Uganda Friendship Hospital-Naguru (CUFH-Naguru). Virological failure has been seen to worsen from 13.1% in January 2017, to 22.2% in June 2018, and this is beyond the acceptable UNAIDS target of 10%. The factors associated with adherence at this hospital are not yet studied. Objectives: The main objective of this study was to determine factors associated with adherence to ART among adolescents attending HIV clinic at CUFH-Naguru, and the levels of adherence. Methodology: A cross-sectional study design was used with mixed methods for data collection. The study utilized secondary data for quantitative analysis of the study outcomes and a qualitative approach to explore the views and experiences of adolescents on factors that influence ART adherence to confirm, cross-validate and corroborate the quantitative findings. 365 ALWHIV aged 10 to 19years, who were active in care at CUFH-Naguru and had been on ART for at least six months were analysed quantitatively. The dependent variable was adherence to ART while independent variables included individual, treatment, health system and social factors. Quantitative data was abstracted from an electronic database (Open MRS), supplemented with information from the medical files and analyzed using STATA 14. Qualitative data was collected using In-depth interviews and IDI guides from 11 ALWHIV who were purposively selected according to their age, sex and adherence status. Modified Poisson regression was used to analyze the factors associated with adherence to ART and the measure of association was prevalence risk ratios. Qualitative data was analyzed using content thematic analysis. Results: There were 365 ALWHIV aged (10-19) years of which 80.3% (293) were female. 82.2% had good adherence to ART. Factors which were significantly associated with good ART adherence included: Age at ART initiation of (5-15) years (APR=0.28; CI: 0.13-0.64) and >15years of age (APR=0.3; CI: 0.14-0.67) and baseline WHO HIV stage, whereas unsuppressed Viral Load (APR=1.97; CI: 1.19-3.27) was significantly associated with poor adherence to ART. Facilitators for ART adherence included: knowledge about HIV disease and ART benefits, presence of a cue, social support from peers/family and recruitment into the adolescent ART clinic. Barriers to ART adherence included: presence of comorbidities, food shortage, ART side effects, pill burden, drug characteristics and inflexible clinic operation time. Conclusion: A good proportion of ALWHIV at CUFH-Naguru had good levels of adherence to ART. This is influenced by individual, treatment, health system and social factors. MoH and other implementing partners should establish adolescent clinics in the various health facilities, enhance recruitment into them of ALWHIV and continuously support them to provide tailored HIV care services.