Facilitators and barriers to antiretroviral therapy adherence among adolescents in Ghana

Abstract

IntroductionAdherence to antiretroviral therapy (ART) is known to be challenging among adolescents living with HIV/AIDS, notwithstanding the life-saving importance of this therapy. Of the global total number of adolescents living with HIV in 2013, 83% reside in sub-Saharan Africa. The study aimed to identify facilitators of and barriers to antiretroviral treatment adherence among adolescents in Ghana.MethodsA cross-sectional qualitative study using semi-structured interviews for data collection was carried out among adolescents (aged 12–19 years) at the adolescents HIV clinic at the Korle-Bu Teaching Hospital in Ghana. Predominantly open-ended questions relating to ART were used. Interviews were done until saturation. In total, 19 interviews were conducted. Analysis was done manually to maintain proximity with the text.FindingsThe main facilitators were support from health care providers, parental support, patient’s knowledge of disease and self-motivation, patient’s perceived positive outcomes, and dispensed formulation. The identified barriers were patient’s forgetfulness to take medicines, perceived stigmatization due to disclosure, financial barriers, and adverse effects of ART. Support from health care workers was the most frequently mentioned facilitator, and patient’s forgetfulness and perceived stigmatization after disclosure were the most frequently mentioned barriers. Self-motivation (knowledge induced) to adhere to treatment was a specific facilitator among older adolescents.ConclusionContinuous information provision in addition to unflinching support from health care workers and parents or guardians may improve adherence among adolescents. Also, interventions to reduce patient forgetfulness may be beneficial. A multi-sectorial approach would be needed to address adolescent disclosure of HIV/AIDS status.

Barriers of adherence to antiretroviral therapy among HIV/AIDS infected persons in Nekemte referral Hospital, East Wollega, Oromia Regional State, Western Ethiopia, 2017

“…More than half (57.90%) of the respondents disclosed their ART status to their family and among those who disclosed their HIV status, 12.10% of them faced problem due to their disclosure. Based on research conducted in Felege Hiwot Hospital of Gonder, Northern Ethiopia, disclosure of HIV status was significantly associated with adherence of ART which have some similarity with current study (Amico et al, 2006;Bezabhe et al, 2014;Katz et al, 2013;Ankrah et al, 2016;Chindedza et al, 2013;Obirikorang et al, 2013).…”

Impact of a youth‐friendly HIV clinic: 10 years of adolescent outcomes in Port‐au‐Prince, Haiti

“…Our results emphasize that implementation of youth-friendly HIV services can improve outcomes, particularly in the first six months after HIV testing; however, pre-ART attrition remains extremely high and more work is needed to engage asymptomatic patients and promptly initiate ART-eligible patients on treatment. The finding that youth-friendly clinic services did not impact long-term retention of ART patients underscores the multiplicity of socio-economic, family and community factors, which acutely influence adolescent behaviour in addition to clinic-level factors [26,27]. …”

Interventions to Improve Antiretroviral Therapy Adherence Among Adolescents and Youth in Low- and Middle-Income Countries: A Systematic Review 2015–2019

“…Adolescents and youth also lack financial autonomy, are prone to peer pressure, and lack problem-solving skills [21][22][23][24][25]. Further, in resource-limited settings, external factors including poverty, food scarcity, and HIV-related stigma acutely influence ART adherence and HIV outcomes [26][27][28][29][30][31][32][33].…”

“…dosing, high pill burden, side effects) [3,38,39]. Much of the research on ART adherence among young people has focused on identifying and estimating the prevalence of these barriers [29,33,38,40,41]. A comprehensive review of the literature between 2003 and 2015 identified 10 studies which evaluated interventions to improve adherence in adolescents in developed countries [42].…”