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

Maria H. Kim, Alick C. Mazenga, Xiaoying Yu, Saeed Ahmed, Mary E. Paul, Peter N. Kazembe, Elaine J. Abrams

Research output: Contribution to journalArticle

25 Citations (Scopus)

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.

CONCLUSION: 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.

Original languageEnglish (US)
Pages (from-to)1-12
Number of pages12
JournalJournal of the International AIDS Society
Volume20
Issue number1
DOIs
StatePublished - Mar 30 2017
Externally publishedYes

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Malawi
HIV
Acquired Immunodeficiency Syndrome
Self Efficacy
Therapeutics
Violence
Emotions
Southern Africa
Disclosure
Social Support
Alcohol Drinking
HIV Infections
Medical Records
Young Adult
Appointments and Schedules
Cross-Sectional Studies
Logistic Models
Alcohols
Depression
Health

Keywords

  • adherence
  • adolescents
  • alcohol
  • Antiretroviral therapy
  • HIV
  • self-efficacy
  • sub-Saharan Africa
  • violence

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi : barriers and associated factors. / Kim, Maria H.; Mazenga, Alick C.; Yu, Xiaoying; Ahmed, Saeed; Paul, Mary E.; Kazembe, Peter N.; Abrams, Elaine J.

In: Journal of the International AIDS Society, Vol. 20, No. 1, 30.03.2017, p. 1-12.

Research output: Contribution to journalArticle

Kim, Maria H. ; Mazenga, Alick C. ; Yu, Xiaoying ; Ahmed, Saeed ; Paul, Mary E. ; Kazembe, Peter N. ; Abrams, Elaine J. / High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi : barriers and associated factors. In: Journal of the International AIDS Society. 2017 ; Vol. 20, No. 1. pp. 1-12.
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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.CONCLUSION: 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.",
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AU - Yu, Xiaoying

AU - Ahmed, Saeed

AU - Paul, Mary E.

AU - Kazembe, Peter N.

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N2 - 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.CONCLUSION: 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.

AB - 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.CONCLUSION: 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.

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KW - adolescents

KW - alcohol

KW - Antiretroviral therapy

KW - HIV

KW - self-efficacy

KW - sub-Saharan Africa

KW - violence

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