Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study

Nyogea, Daniel, Mtenga, Sally, Henning, Lars, Franzeck, Fabian C., Glass, Tracy R., Letang, Emilio, Tanner, Marcel, and Geubbels, Eveline (2015) Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study. BMC Infectious Diseases, 15 (28). pp. 1-13.

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Abstract

Background: Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan Africa. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART adherence among children and teenagers in rural Tanzania.

Methods: We applied a sequential explanatory mixed method design targeting children and teenagers aged 2–19 years residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining focus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined optimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic regression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored issues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was analysed using thematic content analysis.

Results: Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the average adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the qualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity, being unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and forgetfulness were seen to be barriers for optimal adherence.

Conclusion: The study has highlighted specific challenges in ART adherence faced by children and teenagers. Having a biological parent as a caretaker remains a key determinant of adherence among children and teenagers. To achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system need to be designed.

Item ID: 49862
Item Type: Article (Refereed Research - C1)
Keywords: ART adherence, children, teenagers, pill count, non-parental caretaker, focus group discussions, in-depth interviews
Additional Information:

© 2015 Nyogea et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

ISSN: 1471-2334
Funders: Global Fund for AIDS, TB and Malaria, Kanton of Basel
Date Deposited: 14 Aug 2017 04:29
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 100%
SEO Codes: 92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920499 Public Health (excl. Specific Population Health) not elsewhere classified @ 100%
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