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Factors Related to Incomplete Adherence to Antiretroviral Therapy among Adolescents Attending Three HIV Clinics in the Copperbelt, Zambia

Abstract

Little is known about adherence to antiretroviral therapy (ART) among adolescents in sub-Saharan Africa, where the majority of the world’s HIV-positive adolescents reside. We assessed individual, household, and HIV self-management characteristics associated with a 48-hour treatment gap in the preceding 3 months, and a pharmacy medication possession ratio (MPR) that assessed the number of ART pills dispensed divided by the number of ART pills required in the past 6 months, among 285 Zambians, ages 15–19 years. Factors significantly associated with a 48-hour treatment gap were being male, not everyone at home being aware of the adolescent’s HIV status, and alcohol use in the past month. Factors associated with an MPR < 90% included attending the clinic alone, alcohol use in the past month, and currently not being in school. Findings support programs to strengthen adolescents’ HIV management skills with attention to alcohol use, family engagement, and the challenges adolescents face transitioning into adulthood, especially when they are no longer in school.

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References

  1. Ferrand RA, Briggs D, Ferguson J, et al. Viral suppression in adolescents on antiretroviral treatment: review of the literature and critical appraisal of methodological challenges. Trop Med Int Health. 2016;21(3):325–33.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ding H, Wilson CM, Modjarrad K, McGwin G, Tang J, Vermund SH. Predictors of Suboptimal Virologic Response to Highly Active Antiretroviral Therapy Among Human Immunodeficiency Virus-Infected Adolescents: analyses of the Reaching for Excellence in Adolescent Care and Health (REACH) Project. Arch Pediatr Adolesc Med. 2009;163(12):1100–5.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Nachega JB, Hislop M, Nguyen H, et al. Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa. J Acquir Immune Defic Syndr (1999). 2009;51(1):65.

    Article  PubMed  PubMed Central  Google Scholar 

  4. WHO. HIV and adolescents: guidance for HIV testing and counselling and care for adolescents living with HIV: recommendations for a public health approach and considerations for policy-makers and managers. 2013.

  5. UNICEF. For every child, end AIDS—Seventh Stocktaking Report. 2016. https://www.unicef.org/publications/files/Children_and_AIDS_Seventh_Stocktaking_Report_2016_EN.pdf.pdf. Accessed 30 Jan 2017.

  6. Mburu G, Hodgson I, Teltschik A, et al. Rights-based services for adolescents living with HIV: adolescent self-efficacy and implications for health systems in Zambia. Reprod Health Matters. 2013;21(41):176–85.

    Article  PubMed  Google Scholar 

  7. Kim S-H, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014;28(13):1945–56.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  8. Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low-and middle-income countries: a systematic review. AIDS Care. 2015;27(7):805–16.

    Article  PubMed  Google Scholar 

  9. Vreeman RC, Wiehe SE, Pearce EC, Nyandiko WM. A systematic review of pediatric adherence to antiretroviral therapy in low-and middle-income countries. Pediatr Infect Dis J. 2008;27(8):686–91.

    Article  PubMed  Google Scholar 

  10. Oyugi JH, Byakika-Tusiime J, Ragland K, et al. Treatment interruptions predict resistance in HIV-positive individuals purchasing fixed-dose combination antiretroviral therapy in Kampala, Uganda. AIDS. 2007;21(8):965–71.

    CAS  Article  PubMed  Google Scholar 

  11. Genberg BL, Wilson IB, Bangsberg DR, et al. Patterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America. AIDS. 2012;26(11):1415 (London, England).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Denison JA, Koole O, Tsui S, et al. Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia. AIDS. 2015;29(3):361 (London, England).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  13. Denison JA, Banda H, Dennis AC, et al. “The sky is the limit”: adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their adult caregivers. J Int AIDS Soc. 2015;18(1):19358.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Stalter RM, Katayamoyo P, Packer C, et al. Transitioning to second-line antiretroviral therapy among adolescents in Copperbelt Province, Zambia: predictors of treatment switching and adherence to second-line regimens. Pediatr Infect Dis J. 2017;36(8):768–73.

    Article  PubMed  Google Scholar 

  15. McMahon JH, Jordan MR, Kelley K, et al. Pharmacy adherence measures to assess adherence to antiretroviral therapy: review of the literature and implications for treatment monitoring. Clin Infect Dis. 2011;52(4):493–506.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64(9):1823–31.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93.

    Article  PubMed  Google Scholar 

  18. Kaaya SF, Fawzi M, Mbwambo J, Lee B, Msamanga G, Fawzi W. Validity of the Hopkins Symptom Checklist-25 amongst HIV-positive pregnant women in Tanzania. Acta Psychiatr Scand. 2002;106(1):9–19.

    CAS  Article  PubMed  Google Scholar 

  19. Vagenas P, Azar MM, Copenhaver MM, Springer SA, Molina PE, Altice FL. The impact of alcohol use and related disorders on the HIV continuum of care: a systematic review. Curr HIV/AIDS Rep. 2015;12(4):421–36.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bava S, Tapert SF. Adolescent brain development and the risk for alcohol and other drug problems. Neuropsychol Rev. 2010;20(4):398–413.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sawyer SM, Drew S, Yeo MS, Britto MT. Adolescents with a chronic condition: challenges living, challenges treating. Lancet. 2007;369(9571):1481–9.

    Article  PubMed  Google Scholar 

  22. Kane JC, Murray LK, Bass JK, Johnson RM, Bolton P. Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI). Drug Alcohol Depend. 2016;166:85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Cluver LD, Hodes RJ, Toska E, et al. ‘HIV is like a tsotsi. ARVs are your guns’: associations between HIV-disclosure and adherence to antiretroviral treatment among adolescents in South Africa. AIDS. 2015;29:S57–65.

    Article  PubMed  Google Scholar 

  24. Kikuchi K, Poudel KC, Muganda J, et al. High risk of ART non-adherence and delay of ART initiation among HIV positive double orphans in Kigali, Rwanda. PLoS ONE. 2012;7(7):e41998.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. Nsheha AH, Dow DE, Kapanda GE, Hamel BC, Msuya LJ. Adherence to antiretroviral therapy among HIV-infected children receiving care at Kilimanjaro Christian Medical Centre (KCMC), Northern Tanzania: a cross-sectional analytical study. Pan Afr Med J. 2014;17(1):238.

    PubMed  PubMed Central  Google Scholar 

  26. Musiime V, Kayiwa J, Kiconco M, et al. Response to antiretroviral therapy of HIV type 1-infected children in urban and rural settings of Uganda. AIDS Res Hum Retrovir. 2012;28(12):1647–57.

    CAS  Article  PubMed  Google Scholar 

  27. Ndiaye M, Nyasulu P, Nguyen H, et al. Risk factors for suboptimal antiretroviral therapy adherence in HIV-infected adolescents in Gaborone, Botswana: a pilot cross-sectional study. Patient Prefer Adherence. 2013;7:891.

    PubMed  PubMed Central  Google Scholar 

  28. Lowenthal E, Marukutira T, Tshume O, et al. Parental absence from clinic predicts human immunodeficiency virus treatment failure in adolescents. JAMA Pediatr. 2015;169(5):498–500.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gross R, Bandason T, Langhaug L, Mujuru H, Lowenthal E, Ferrand R. Factors associated with self-reported adherence among adolescents on antiretroviral therapy in Zimbabwe. AIDS Care. 2015;27(3):322–6.

    Article  PubMed  Google Scholar 

  30. Bernays S, Paparini S, Seeley J, Rhodes T. “Not Taking it Will Just be Like a Sin”: Young People Living with HIV and the Stigmatization of Less-Than-Perfect Adherence to Antiretroviral Therapy. Med Anthropol. 2017;18:1–5.

    Google Scholar 

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Acknowledgements

We are grateful to the adolescents who participated in this study. We appreciate the support and guidance of the staff at the health facilities where this research was conducted. We also thank Samuel Field of FHI 360 for his statistical advice and Suzanne Fischer for her technical writing and editing skills.

Disclaimer

The contents do not necessarily reflect the views of USAID or the United States government.

Funding

This work was made possible by the generous support of the American people through the U.S. Agency for International Development (USAID). Financial assistance was provided by USAID to FHI 360 under the terms of the Preventive Technologies Agreement No. GHO-A-00-09-00016-00. This publication was made possible with help from the Johns Hopkins University Center for AIDS Research, an NIH funded program (P30AI094189), which is supported by the following NIH Co-Funding and Participating Institutes and Centers: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, NIGMS, NIDDK, and OAR. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Correspondence to Julie A. Denison.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Denison, J.A., Packer, C., Stalter, R.M. et al. Factors Related to Incomplete Adherence to Antiretroviral Therapy among Adolescents Attending Three HIV Clinics in the Copperbelt, Zambia. AIDS Behav 22, 996–1005 (2018). https://doi.org/10.1007/s10461-017-1944-x

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  • DOI: https://doi.org/10.1007/s10461-017-1944-x

Keywords

  • HIV
  • Adherence
  • Sub-Saharan Africa
  • Adolescents
  • Zambia
  • Antiretroviral therapy (ART)
  • Caregivers
  • Youth