Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand

Abstract

BackgroundExisting studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children.MethodsWe used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12–19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010–2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART.ResultsFrom the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor.ConclusionOur findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in recognizing and addressing challenging situations related to ART taking.

Loss to follow‐up and mortality among HIV‐infected adolescents receiving antiretroviral therapy in Pune, India

“…Firstly, the fear of social ostracization, resulting from greater awareness of the stigmatization around HIV in late adolescence, could negatively impact attendance at an ART centre [21]. Secondly, this period is associated with sexual debut for some adolescents; [7] apprehension about inadvertent partner disclosure, if seen at the ART centre, along with reduced adult supervision, could further limit follow-up [22]. Lastly, the transition into adulthood may be associated with greater familial responsibilities for some adolescents, relegating personal health to a secondary priority [23,24].…”

Factors Influencing Adherence to Antiretroviral Therapy among HIV Positive Adolescents at Adult Infectious Diseases Center in Lusaka, Zambia

“…Literature has shown that with the advances in effectiveness and availability of cART, HIV infected children are now surviving to adolescence and emerging as a new group in the global HIV/AIDS pandemic [24]. It has been also cited that despite the fact that HIV positive adolescents find it a challenge living with the HIV, they have remained positive and focused with their education [24].…”

“…In other reports, the overall level of comprehensive correct knowledge of HIV and AIDS remains very low among older adolescents aged 15 -19 [23]. However some studies found that HIV-infected adolescents demonstrated good knowledge regarding HIV/AIDS and cART, including the consequences of developing drug resistance with suboptimal cART adherence [24]. Despite some reports that HIV positive adolescents have good knowledge regarding HIV/AIDS progression, non-adherence to cART and treatment failure have remained prevalent in this age group.…”

Drug Resistance Among Adolescents and Young Adults with Virologic Failure of First-Line Antiretroviral Therapy and Response to Second-Line Treatment

“…Additional barriers to VLS in adolescents include drug toxicity and intolerance, psychological problems (depression, anxiety, and trauma) and social barriers, including stigma, have been linked to poor treatment adherence in adolescents and young adults. [57][58][59][60] Important limitations of the study are that genotyping results after first-line ART failure were not always available in realtime to health care providers for the optimization of ART before switching to second-line regimens. In addition, limited adherence and ATV/r as second-line ART may have reduced the rate of VS 50 .…”