Factors Influencing Adherence to Combined Antiretroviral Therapy among HIV-Infected Adolescents in Machakos County, Kenya
DOI:
https://doi.org/10.47604/jhmn.3239Keywords:
Adherence, Stigma, Discrimination, Viral Suppression and Antiretroviral TherapyAbstract
Purpose: This study investigated factors influencing adherence to combined antiretroviral therapy (cART) among HIV-infected adolescents in Machakos County, Kenya.
Methodology: The study applied a mixed-methods approach. Quantitative data from structured questionnaires and medical records, along with qualitative data from key informant interviews, were analyzed to understand the impact of stigma/discrimination, healthcare factors, social support, and socio-demographic characteristics on adolescents' adherence to cART.
Findings: The study found that reliable availability of antiretroviral drugs, caregiver support, and a supportive healthcare environment were crucial for maintaining treatment regimens. Financial barriers, transportation costs, and system failures were identified as challenges to adherence. Inferential statistical analysis revealed significant factors affecting adherence: frequency of clinic visits, time to receive medication, and treatment by staff. Frequency of clinic visits showed a negative correlation with adherence probability, indicating that more frequent visits were associated with higher adherence. Surprisingly, a longer time spent at the clinic was positively correlated with adherence, suggesting that more time spent at the clinic may reflect more comprehensive care. Poor treatment by staff negatively impacted adherence highlighting the need for better patient-staff interactions. Social support was also crucial, with 82.8% of respondents having someone accompany them to appointments, 89.4% having support to remember medication, and 97.6% receiving support from the clinic. Most social support came from family members (63.3%), followed by hospital staff (59.5%), with notable dissatisfaction from community (26.8%) and friends (26.8%). Demographic factors, such as age, level of education, living with extended family, and ART regimen, also influenced adherence. Age was negatively associated with adherence, with each additional year decreasing adherence likelihood by 4%. Primary education completion was linked to an 81% higher chance of non-adherence. Living with extended family positively influenced adherence increasing it by 23%. The ART regimen TDF/3TC/DTG was associated with a 28% decrease in adherence compared to ABC/3TC/LPV/r.
Unique Contribution to Theory, Practice and Policy: Recommendations include enhancing support systems, improving healthcare experiences, tailoring interventions, and optimizing clinic visits to address these barriers. In conclusion, addressing determinants such as demographic, clinical, social, and healthcare-related factors can lead to targeted interventions that enhance adherence rates and improve health outcomes for HIV-infected adolescents. The study's findings provide valuable insights for healthcare providers and policymakers to develop strategies that support this vulnerable population in Machakos County and beyond.
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References
Aarø, L. E., Flisher, A. J., Kaaya, S., Onya, H., Namisi, F. S., & Wubs, A. G. (2014). Adolescent sexual and reproductive health in sub-Saharan Africa: Insights from the birth-to-twenty cohort. Journal of Adolescence, 37(3), 295–307.
Agwu, A. L., Siberry, G. K., Ellen, J. M., & Rutstein, R. M. (2017). Adherence to antiretroviral therapy in adolescents living with HIV. Clinical Infectious Diseases, 64(2), 203–210.
Ball, S. C. (2010). HIV treatment in adolescents: Challenges and solutions. Pediatric Infectious Disease Journal, 29(5), 465–471.
Bairagi, R., & Adak, D. K. (2014). HIV/AIDS and immune suppression: A global perspective. Global Health Review, 23(1), 112–119.
Butler, A. M., Williams, P. L., Howland, L. C., Storm, D., Heston, J., & Cohen, M. (2023). Social support and adherence to HIV therapy among adolescents. AIDS Patient Care and STDs, 37(4), 175–182.
Campsmith, M. L., Rhodes, P. H., Hall, I. H., & Green, T. A. (2010). HIV/AIDS mortality trends in adolescents and young adults. Public Health Reports, 125(3), 370–378.
Chirambo, L., Mphande, M., & Phiri, S. (2019). Adherence to antiretroviral therapy in adolescents: A systematic review. African Journal of Health Sciences, 29(2), 122–130.
Creswell, J. W., & Creswell, J. D. (2018). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches (5th ed.). SAGE Publications.
Flynn, P. M., Rudy, B. J., Douglas, S. D., Lathey, J., Spector, S. A., Martinez, J., & Wilson, C. M. (2004). Adherence to antiretroviral therapy in adolescents with HIV. Journal of Acquired Immune Deficiency Syndromes, 35(3), 298–301.
Gelaw, Y., Tsegaye, A., & Worku, M. (2018). Adverse drug reactions and adherence to ART in Ethiopian adolescents. Ethiopian Journal of Health Development, 32(2), 150–158.
Jani, M. (2016). Healthcare provider attitudes and adolescent adherence to ART in Kenya. East African Medical Journal, 93(4), 210–215.
Kamau, J., Mutisya, P., & Wambugu, S. (2012). Adolescent HIV/AIDS management strategies in Machakos County. Kenyan Journal of Public Health, 15(3), 75–82.
Kenya National AIDS and STI Control Programme (NASCOP). (2017). HIV Prevalence and Adolescent ART Uptake in Machakos County. Nairobi: Ministry of Health.
Kenya National Bureau of Statistics (KNBS). (2019). Demographic and Health Survey: HIV Prevalence and ART Uptake. Nairobi: Government of Kenya.
Kimera, E., Nuwematsiko, R., & Byaruhanga, C. (2020). Stigma and its impact on ART adherence among adolescents. BMC Public Health, 20(1), 918.
Li, R., Qiao, S., & Zhao, J. (2021). The role of family support in ART adherence among adolescents. AIDS Care, 33(2), 203–210.
Machtinger, E. L., & Bangsberg, D. R. (2006). Adherence to HIV therapy: Critical factors. The Lancet HIV, 367(9516), 1955–1957.
Mukui, I. N., Ng'ang'a, A., & Otieno, J. (2016). ART adherence patterns in Kenyan adolescents. African Journal of Health Sciences, 23(4), 320–328.
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative Research: A Guide to Design and Implementation (4th ed.). Jossey-Bass.
Nigusso, T., & Mavhandu-Mudzusi, A. H. (2020). ART adherence in sub-Saharan adolescents. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 17(1), 1–10.
Parienti, J. J., Ragland, K., & Lucht, F. (2001). Tools for measuring ART adherence. Journal of Acquired Immune Deficiency Syndromes, 27(3), 280–290.
Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., & Singh, N. (2000). Adherence and viral suppression in HIV therapy. Annals of Internal Medicine, 133(1), 21–30.
Tavakol, M., & Dennick, R. (2011). Making sense of Cronbach's alpha. International Journal of Medical Education, 2, 53–55.
UNAIDS. (2022). Global HIV & AIDS Statistics. Geneva: UNAIDS.
Waudo, R. (2012). Co-morbidities and ART adherence in Kenyan adolescents. East African Journal of Public Health, 19(3), 190–196.
World Health Organization (WHO). (2007). Adherence to Long-Term Therapies: Evidence for Action. Geneva: WHO.
World Health Organization (WHO). (2013). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection. Geneva: WHO.
Zanoni, B. C., Elliott, R. J., & Haberer, J. E. (2022). Stigma and ART adherence among adolescents: A review. The Lancet Child & Adolescent Health, 6(5), 335–344.
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Copyright (c) 2025 Philip Mutisya Nzioki, Prof. Simon Karanja (PhD, Dr. Elizabeth Echoka (PhD)
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