Factors influencing anti-retroviral therapy adherence of hiv-positive adolescents in Nairobi, Kenya: a qualitative study

Abstract

The advances in HIV care have given rise to a population, including adolescents, that is living longer with HIV. In Kenya, prevalence estimates for HIV-positive youth aged 15-24 years in 2007 was 3.8%. With the advent of HAART, HIV is now considered a chronic condition. Adherence with ~ 95% of prescribed doses is required to prevent treatment failure and development of resistance to ART, outcomes that would affect not only the individual, but also the community at large. Despite this, research shows that actual adherence levels often fall far below those required. This can have dire consequences in a resource-limited setting such as Kenya. Caring for the adolescent living with HIV/AIDS is especially challenging considering the impact the disease has on their well being, which impacts on their adherence to medication. They are a heterogeneous group that we need to know more about if we are to provide optimal care. This study aimed to describe the level of understanding regarding HIV and ART adherence and to determine the factors influencing adherence among HIV-infected adolescents on HAART aged 13-19 years in Nairobi, in addition to what interventions they would find acceptable in facilitating their adherence. Qualitative in-depth interviews and focus group discussions were conducted with adolescents to fulfill these objectives. The study found that many HIV-infected adolescents on HAART basically understood what HIV is and generally adhered to their ARVs, with support and encouragement from family. However, quite a number ofthem still expressed confusion, ignorance, non-adherence and non-acceptance concerning their status and medications while living daily with the fear of HIV/ AIDS stigma. They also faced adherence challenges including time management and stress. There is a need for specialized care for the HIV-positive adolescent including targeted counseling and peer support groups sessions. Stigma-reduction awareness programs and medication diaries are intervention options worth considering to support adherence among this population.