A Qualitative Assessment of the Determinants of Adherence to Antiretroviral Therapy among Adolescents living with HIV in the Centre Region of Cameroon

Ketchaji, Alice; Ngouakam, Herman; Assah, Félix; Ndjalla, Alexandre; Monebenimp, Francisca; Marcelin, Ngowe Ngowe

doi:10.26502/jesph.96120067

Cited by 4 publications

(6 citation statements)

References 19 publications

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“…Interpretation: the proportion of non-adherence in this study was lower than performance observed in other studies where adherence was measured through pill count and VL [ 8 , 11 , 13 , 17 ]. This low proportion might be attributed to the qualitative measure, which revealed only 7.2% of non-adherent.…”

Section: Discussioncontrasting

confidence: 78%

“…Limitations: the main limitation of this study was the measure of non-adherence through a self-reported questionnaire. This method is not the most sensitive for identifying non-adherent, due to possible memory bias [ 2 , 11 , 13 ]. To limit this bias, non-adherence was assessed during the 3 days preceding inclusion.…”

Section: Discussionmentioning

confidence: 99%

“…At the Dschang District Hospital, a cross-sectional study found that the rate of non-adherence was 19.8% [ 12 ]. In the Center Region of Cameroon, a cross-sectional study conducted among 401 adolescents receiving ART revealed that living beyond 5 km from the heath facility, taking medications in the same service with adults and managed at a rural health facility without regular counseling were associated with non-adherence [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Factors associated with non-adherence to antiretroviral therapy among HIV-infected adolescents aged 15-19 years: a snapshot from the Mother and Child Center in Yaounde, Cameroon

et al. 2021

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Introduction non-adherence to antiretroviral therapy (ART) constitutes the main cause of therapeutic failure among HIV-infected adolescents, especially in the aged group 15 to 19 years. We aimed to determine factors associated with this non-adherence in this specific population. Methods we conducted a cross-sectional study at the Mother and Child Center in Yaounde from August to October 2018. Delayed clinic appointment was referred to as defaulters. Non-adherence was measured during the 3 days preceding inclusion by self-reported method following quantitative (missing dosage of ART), qualitative (ART taken with a delay of more than 2 hours) and combined measure. A threshold of non-adherence > 20% was considered high, with p<0.05 statistically significant. Results overall, 195 out of 251 (77.7%) eligible adolescents were included, of which 56.9% were girls (sex-ratio = 4/3). The mean age was 16.8 ± 1.5 years. The rate of defaulters was 21.0%. Following quantitative approach, 33.8% were non-adherent. Using combined approach, we had 41.0%. This non-adherence was associated with duration on ART > 5 years (adjusted Odds Ratio [aOR]: 2.33;95% Confidence Interval [CI]: 1.08-5.00; p:0.030), defaulters (aOR: 2.56;95% CI: 1.12-5.82; p:0.025) and HIV Viral Load (VL) ≥ 40 copies/ml (aOR: 0.42; 95% CI: 0.21-0.83; p:0.013). Conclusion at this reference pediatric center, 4 out of 10 adolescents aged 15-19 years on ART are non-adherent, driven by missing dosage of drug intake. Strategies for enhanced adherence for late age adolescents are therefore warranted, by prioritizing interventions on defaulters and duration on ART > 5 years.

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Section: Discussioncontrasting

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Factors associated with non-adherence to antiretroviral therapy among HIV-infected adolescents aged 15-19 years: a snapshot from the Mother and Child Center in Yaounde, Cameroon

et al. 2021

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“…In France, Trocmé et al [6] found 79% non‐compliance among adolescents for various reasons, including forgetfulness and voluntary refusal. In Cameroon, in 2019, Ketchaji et al [20] reported poor compliance among 25.1% of adolescents living with HIV. All these disparities could be explained by the subjectivity of this parameter and the multiple evaluation methods used.…”

Section: Discussionmentioning

confidence: 99%

Archiving of mutations in HIV‐1 cellular reservoirs among vertically infected adolescents is contingent with clinical stages and plasma viral load: Evidence from the EDCTP‐READY study

et al. 2021

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Introduction Globally, HIV‐related adolescent deaths have increased about 50%, especially for those who are vertically infected. This could be driven by archived drug resistance mutations (DRMs) as children grow up, which might jeopardize antiretroviral therapy (ART). Our objective was to compare HIV‐1 genotypic variation between plasma RNA and proviral DNA of vertically infected adolescents (aged 10–19 years) failing ART. Methods A comparative study was conducted in 2019 among 296 adolescents with perinatal HIV infection (ALPHI) failing ART in health facilities of the Centre Region of Cameroon. The WHO clinical stage, CD4 count and plasma viral load (PVL) were measured. For those failing ART (PVL ≥ 1000 copies/mL), RNA (plasma) and proviral DNA (buffy coat) were sequenced in the pol gene at Chantal BIYA International Reference Centre (CIRCB), Yaoundé, Cameroon. HIV‐1 subtypes and DRMs were interpreted using Stanford HIVdb v.8.8 and MEGA‐X. Results Of the 30% (89/296) failing ART, 81 had both RNA and DNA sequences generated and three were excluded for APOBEC mutations: the mean age was 16 ± 3 years; female‐to‐male ratio was 3:5; median PVL was 46 856 copies/mL [interquartile range (IQR): 19 898–271 410]; median CD4 count was 264 cells/μL (IQR: 131–574); and 42% were at WHO clinical stage 3/4. Subtype concordance between RNA and DNA viral strains was 100%, with CRF02_AG being predominant (65%) and two potential new recombinants found (A1/G/K; F1/G). Adolescents with DRMs were significantly higher in plasma than in proviral DNA (92% vs. 86%, p < 0.0001). Prevalent DRMs by drug class (RNA vs. DNA respectively) were at position M184 (74% vs. 67%) for nucleoside reverse transcriptase inhibitors (NRTIs), K103 (63% vs. 59%) for non‐NRTIs, and V82, L76 and M46 (2% vs. 2%) for protease inhibitors. A total of 35% (27/78) of adolescents had concordant DRM profiles in RNA and DNA, while 27% (21/78) had DRMs only in proviral DNA. The presence of archived DRMs was associated with advanced clinical stage 3/4 (OR = 0.14, p = 0.0003) and PVL < 5 Log (Copies/mL) (OR: 4.88, p = 0.006). Conclusions Although plasma RNA remains more sensitive for detecting HIV‐1 DRMs, about a quarter of ALPHI experiencing ART failure in an African setting might have archived DRMs in viral reservoirs, indicating clinically occult resistance. Thus, to ensure effective ART success, proviral DNA profiling (alongside RNA genotyping) would provide additional DRMs for adolescents with advanced clinical stages and/or moderate PVL.

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“…Hazard factors of non-adherence were evaluated, Mean age was 14.63 (±2.89) and 55.9 % (224) were female. Non-adherence was related with "living away about 5 km from the heath office" (OR 1.84, 95% CI: 1.01-3.33, p=0.045); "young people taking prescription in a same service with adults" (OR 0.11, 95% CI: 0.03-0.35, p<0.001), managed at countryside health office (OR 4.29, 95% CI: 1.84-9.96, p=0.001) and not guided consistently (OR 0.02, 95% CI: 0.01-0.36, p=0.007) (Ketchaji et al, 2019).…”

Section: Chapter 02: Literature Reviewmentioning

confidence: 99%

Determinants of Non-Adherence to Anti-Retroviral Therapy in HIV/AIDS Patients of HIV Centre Jinnah Hospital

2022

JHMN

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Introduction: Human immunodeficiency virus is very harmful to human's immune system. This virus can further cause specific contaminations and tumors in humans. The HIV-contaminated populace is at a higher danger of AIDS-characterizing tumors, for example, Kaposi sarcoma, non-Hodgkin lymphoma, and cervical malignant growth. Since the coming of exceptionally dynamic antiretroviral treatment (HAART) in 1996, the endurance of HIV-tainted populace in the United States has expanded significantly (Shiels et al., 2011).Methods: A descriptive study conducted at HIV centre Jinnah Hospital Allama Iqbal Medical College Lahore. Data was collected through questionnaire from patients of HIV clinic. Data was analysed by SPSS version 21.0, frequency, percentage and standard deviation was found with statistics of pie charts and histogram.Results: From one hundred participants 100(100%) shows forgetfulness , 29(29%) shows missing appointments, 33(33%) shows run out of medication, 11(11%) shows depression, anger, despair. 78(78%) don't think that ART helps ,only 4(4%) shows side effects of ART and 1(1%) shows other reason for non-adherence. Conclusions: The outcomes gave basic and valuable data that will help in decreasing the factors that are causing non-adherence to ART.

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A Qualitative Assessment of the Determinants of Adherence to Antiretroviral Therapy among Adolescents living with HIV in the Centre Region of Cameroon

Cited by 4 publications

References 19 publications

Factors associated with non-adherence to antiretroviral therapy among HIV-infected adolescents aged 15-19 years: a snapshot from the Mother and Child Center in Yaounde, Cameroon

Factors associated with non-adherence to antiretroviral therapy among HIV-infected adolescents aged 15-19 years: a snapshot from the Mother and Child Center in Yaounde, Cameroon

Archiving of mutations in HIV‐1 cellular reservoirs among vertically infected adolescents is contingent with clinical stages and plasma viral load: Evidence from the EDCTP‐READY study

Determinants of Non-Adherence to Anti-Retroviral Therapy in HIV/AIDS Patients of HIV Centre Jinnah Hospital

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