FACTORS INFLUENCING ADHERENCE TO ANTIRETROVIRAL THERAPY AMONG ADOLESCENTS ATBUSIA COUNTY REFERRAL HOSPITAL (KENYA)
Keywords:
Adolescents, HIV, factors, ART Adherence, Treatment Supporter.Abstract
Background: Adherence, retention in care, and treatment efficacy are critical for viral suppression among persons living with HIV. Adolescents face unique challenges affecting adherence, including dependency on caregivers, psychosocial pressures, and school constraints. In Kenya, while overall viral suppression is high, adolescents consistently show lower adherence and viral suppression compared to national targets.
Understanding adherence levels and influencing factors in this age group is essential.
Objective: To evaluate antiretroviral therapy (ART) adherence and identify
demographic, socioeconomic, and health system factors influencing adherence among adolescents at Busia County Referral Hospital, Kenya.
Materials and methods: A cross-sectional mixed-methods design was applied with 148 adolescents recruited through simple random sampling between February and April 2022. Structured questionnaires captured demographic, socioeconomic, and health system data, alongside self-reported ART adherence. Adherence was measured using the Morisky Medication Adherence Scale (MMAS-4) and validated with Pill Count.
Key informant interviews with four healthcare workers provided qualitative insights. Quantitative data were analyzed using SPSS v23.0, and qualitative data were thematically analyzed using NVivo v14.
Results: Adherence was 75.7% (MMAS-4) and 76.4% (Pill Count), showing substantial agreement (κ = 0.78, p < 0.001). Multivariate analysis identified five independent predictors: presence of a treatment supporter (AOR = 5.70; 95% CI: 1.80–17.96; P = 0.003), permanent housing (AOR = 2.86; 95% CI: 1.13–7.26; P = 0.026), proximity to care (AOR = 0.41; 95% CI: 0.19–0.91; P = 0.028), positive health worker behavior (AOR = 3.13; 95% CI: 1.06–9.25; P = 0.038), and provider competence (AOR = 6.84; 95% CI: 1.35–34.76;
P = 0.02).
Conclusion: Antiretroviral therapy adherence among adolescents is influenced by demographic, social, and health system factors. Strengthening caregiver and peer support, improving housing stability, enhancing proximity to care, and ensuring adolescent-friendly, competent health services are essential to improve adherence and achieve optimal viral suppression in this population.
