To address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV.
In this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data.
The median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication.
A supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.
Citation: Sphiwe Madiba, Ntaoleng Mohlabane. Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: a cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho[J]. AIMS Public Health, 2021, 8(3): 541-552. doi: 10.3934/publichealth.2021044
To address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV.
In this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data.
The median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication.
A supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.
antiretroviral therapy
perinatal HIV
sexual and reproductive health
sub-Saharan Africa
[1] | UNICEF (2019) Adolescent HIV prevention. Turning the tide against will require more concentrated focus on adolescents and young people Available from: https://www.data.unicef.org/tpoic/hivaids/adolescents-young-people. |
[2] | Denison JA, Banda H, Dennis AC, et al. (2015) “The sky is the limit”: adhering to antiretroviral therapy and HIV self-management from the perspectives of adolescents living with HIV and their adult caregivers. J Int AIDS Soc 18: e19358. doi: 10.7448/IAS.18.1.19358 |
[3] | LePHIA (2017) Lesotho Population Based HIV Impact Assessment (2016–2017) Maseru, Lesotho: Ministry of Health, Available from: https://phia.icap.columbia.edu/wp-content/uploads/2018/02/Lesotho-Summary-Sheet_A4.2.7.18.HR_.pdf. |
[4] | Hawkins A, Evangeli M, Sturgeon K, et al. (2016) Episodic medication adherence in adolescents and young adults with perinatally acquired HIV: a within-participants approach. AIDS Care 28: 68-75. doi: 10.1080/09540121.2016.1146210 |
[5] | Haberer JE, Sabin L, Amico KR, et al. (2017) Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc 20: e21371. doi: 10.7448/IAS.20.1.21371 |
[6] | Adejumo OA, Malee KM, Ryscavage P, et al. (2015) Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review. J Int AIDS Soc 18: e20049. doi: 10.7448/IAS.18.1.20049 |
[7] | Inzaule SC, Hamers RL, Kityo C, et al. (2016) Long-Term Antiretroviral Treatment Adherence in HIV-Infected Adolescents and Adults in Uganda: A Qualitative Study. PLoS One 11: e0167492. doi: 10.1371/journal.pone.0167492 |
[8] | Kalomo EN, Liao M, Besthorn F, et al. (2017) To tell or not to tell: Dimensions of disclosure to children with HIV in the Zambezi region of Northern Namibia. J HIV AIDS Soc Serv 16: 250-268. doi: 10.1080/15381501.2017.1341359 |
[9] | Kiwanuka J, Mulogo E, Haberer JE (2014) Caregiver Perceptions and Motivation for Disclosing or Concealing the Diagnosis of HIV Infection to Children Receiving HIV Care in Mbarara, Uganda: A Qualitative Study. PLoS One 9: e93276. doi: 10.1371/journal.pone.0093276 |
[10] | Vreeman RC, Nyandiko WM, Liu H, et al. (2014) Measuring adherence to antiretroviral therapy in children and adolescents in western Kenya. J Int AIDS Soc 17: e19227. doi: 10.7448/IAS.17.1.19227 |
[11] | Iacob SA, Iacob DG, Jugulete G (2017) Improving the adherence to antiretroviral therapy, a difficult but essential task for a successful HIV treatment—clinical points of view and practical considerations. Front Pharmacol 8: e831. doi: 10.3389/fphar.2017.00831 |
[12] | Haberer JE, Cook A, Walker AS, et al. (2011) Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects. PloS One 6: e18505. doi: 10.1371/journal.pone.0018505 |
[13] | Nglazi MD, Kranzer K, Holele P, et al. (2012) Treatment outcomes in HIV-infected adolescents attending a community-based antiretroviral therapy clinic in South Africa. BMC Infect 12: 1-7. doi: 10.1186/1471-2334-12-1 |
[14] | Agwu AL, Fairlie L (2013) Antiretroviral treatment, management challenges and outcomes in perinatally HIV-infected adolescents. J Int AIDS Soc 16: e18579. doi: 10.7448/IAS.16.1.18579 |
[15] | Bukenya D, Mayanja BN, Nakamanya S, et al. (2019) What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda. AIDS Res Ther 16: 1-9. doi: 10.1186/s12981-018-0214-y |
[16] | Madiba S, Josiah U (2019) Perceived Stigma and Fear of Unintended Disclosure are Barriers in Medication Adherence in Adolescents with Perinatal HIV in Botswana: A Qualitative Study. Biomed Res Int e9623159. |
[17] | Ankrah DN, Koster ES, Mantel-Teeuwisse AK, et al. (2016) Facilitators and barriers to antiretroviral therapy adherence among adolescents in Ghana. Patient Prefer Adherence 10: 329-337. doi: 10.2147/PPA.S96691 |
[18] | WHO (2019) Adolescent friendly health services for adolescents living with HIV: from theory to practice. Technical Brief Geneva, Switzerland: World Health Organization, Available from: https://apps.who.int/iris/bitstream/handle/10665/329993/WHO-CDS-HIV-19.39-eng.pdf. |
[19] | EGPAF (2017) A tool to enhancetreatment for adolescents and young people living with HIV in Lesotho. Elizabeth Glaser Pediatric AIDS Foundation Available from: https://www.pedaids.org/wp-content/uploads/2018/04/EGPAF-Lesotho-Peer-Support-Group-Guide-PSC-approved_July-2017.pdf. |
[20] | McBride K, Parent J, Mmanga K, et al. (2019) ART adherence among Malawian youth enrolled in teen clubs: a retrospective chart review. AIDS Behav 23: 2629-2633. doi: 10.1007/s10461-019-02580-y |
[21] | Munyayi FK, van Wyk BE (2020) The Comparison of Teen Clubs vs. Standard Care on Treatment Outcomes for Adolescents on Antiretroviral Therapy in Windhoek, Namibia. AIDS Res Ther e8604276. |
[22] | Chesney MA, Ickovics J, Chambers D, et al. (2000) Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care 12: 255-266. doi: 10.1080/09540120050042891 |
[23] | Ferrand RA, Luethy R, Bwakura F, et al. (2007) HIV infection presenting in older children and adolescents: a case series from Harare, Zimbabwe. Arch Clin Infect Dis 44: 874-878. doi: 10.1086/511878 |
[24] | Mokgatle MM, Madiba S (2015) The burden of disease on HIV-infected orphaned and non-orphaned children accessing primary health facilities in a rural district with poor resources in South Africa: a cross-sectional survey of primary caregivers of HIV-infected children aged 5–18 years. Infect Dis Poverty 4: 1-13. doi: 10.1186/s40249-015-0049-x |
[25] | Boender TS, Sigaloff KC, Kayiwa J, et al. (2012) Barriers to initiation of pediatric HIV treatment in Uganda: a mixed-method study. AIDS Res Ther e817506. |
[26] | Madiba S, Mokgatle M (2017) Fear of stigma, beliefs, and knowledge about HIV are barriers to early access to HIV testing and disclosure for perinatally infected children and adolescents in rural communities in South Africa. S Afr Fam Pract 59: 175-181. doi: 10.1080/20786190.2017.1329489 |
[27] | Lowenthal ED, Jibril HB, Sechele ML, et al. (2014) Disclosure of HIV status to HIV-infected children in a large African treatment center: Lessons learned in Botswana. Child Youth Serv Rev 45: 143-149. doi: 10.1016/j.childyouth.2014.03.031 |
[28] | Gross R, Bandason T, Langhaug L, et al. (2015) Factors associated with self-reported adherence among adolescents on antiretroviral therapy in Zimbabwe. AIDS Care 27: 322-326. doi: 10.1080/09540121.2014.969676 |
[29] | WHO (2014) Adolescent HIV Testing, Counselling And Care: Implementation Guidelines For Health Providers And Planners Geneva, Switzerland: Available from: http://apps.who.int/iris/bitstream/handle/10665/94334/9789241506168_eng.pdf?sequence=1. |
[30] | Ankrah DN, Koster ES, Mantel-Teeuwisse AK, et al. (2016) Facilitators and barriers to antiretroviral therapy adherence among adolescents in Ghana. Patient Prefer Adherence 10: 329-337. doi: 10.2147/PPA.S96691 |
[31] | Madiba S, Mokgatle M (2016) Perceptions and Experiences about Self-Disclosure of HIV Status among Adolescents with Perinatal Acquired HIV in Poor-Resourced Communities in South Africa. AIDS Res Ther e2607249. |
[32] | Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, et al. (2015) Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect 15: 1-10. doi: 10.1186/s12879-014-0722-x |
[33] | Damulira C, Mukasa MN, Byansi W, et al. (2019) Examining the relationship of social support and family cohesion on ART adherence among HIV-positive adolescents in southern Uganda: baseline findings. Vulnerable Child Youth Stud 14: 181-190. doi: 10.1080/17450128.2019.1576960 |
[34] | Nabunya P, Bahar OS, Chen B, et al. (2020) The role of family factors in antiretroviral therapy (ART) adherence self-efficacy among HIV-infected adolescents in southern Uganda. BMC Public Health 20: 1-9. doi: 10.1186/s12889-019-7969-5 |