Factors influencing adherence to antiretroviral therapy among young adults in Limpopo province

Suboptimal adherence to antiretroviral treatment and its predictors among people living with HIV in the era of test and treat

Despite the success in scaling-up antiretroviral therapy (ART) services in Ethiopia, suboptimal adherence to ART has been an existing challenge. There is a dearth of evidence on the status of adherence to ART following the adoption of test and treat strategy in Ethiopia. This study aimed to investigate on the magnitude of suboptimal adherence and its predictors among patients taking ART. A multicenter prospective cohort study was conducted among adults aged 15 years and above who started ART between March and June 2019 in 39 health facilities (HFs) in Ethiopia. Measurements on sociodemographic, behavioral, and clinical characteristics were taken at baseline and 6- and 12-months following ART initiation. Multivariable logistic regression model using generalized estimating equations was used to identify factors associated with suboptimal adherence. In total, 1229 individuals who started ART were included in the study. The proportion of suboptimal adherence was 8.0% and 7.9% at 6- and 12-months, respectively. Younger age (adjusted odds ratio (AOR) = 2.28 (95% confidence interval (CI) 1.10, 4.74)), being single (AOR = 2.08 (95% CI 1.25, 3.48)), and being a farmer (AOR = 3.21 (95% CI 1.84, 5.61)) were associated with increased risk for suboptimal adherence. Similarly, alcohol intake (AOR = 3.31 (95% CI 2.14, 5.11)), missing clinic appointment (AOR = 5.73 (95% CI 3.76, 8.75)), having opportunistic infections (AOR = 2.86 (95% CI 1.67, 4.88)) and presence of comorbidities (AOR = 3.51 (95% CI 1.89, 6.53)) were associated with higher risk for suboptimal adherence. We observed lower rate of suboptimal adherence to ART following the implementation of test and treat strategy in Ethiopia. Various sociodemographic, clinical, and behavioral factors were found to be independent predictors of suboptimal adherence. The findings highlight the importance of person-centered adherence support based on individual characteristics.

Facilitators and Barriers to Antiretroviral Therapy Adherence Among Adolescents and Young Adults in Sub-Saharan Africa: A Scoping Review

Background: Globally, approximately 65% of adolescents undergoing antiretroviral therapy (ART) adhered to their treatment, whereas only 55% achieved viral suppression in 2023. The low rate of viral suppression is concerning, as elevated viral loads are associated with a heightened risk of opportunistic infections, progression to advanced HIV disease, increased mortality, and greater HIV transmission rates. We conducted this scoping review to identify the facilitators and barriers to ART adherence among adolescents and young adults (AYAs) in sub-Saharan Africa (SSA). Methods: We conducted this scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. We searched for peer-reviewed articles published in English from 2014 to 2024 across the SCOPUS, ScienceDirect, PubMed, Africa Journals Online, and Google Scholar databases. Two reviewers independently selected the articles and extracted the data. We used NVivo to develop codes and categories of facilitators and barriers. Results: We used 30 articles reporting on studies conducted in 13 countries in this review. The total number of participants in the studies was 12,250. Sixteen articles reported on qualitative studies, nine on quantitative studies, and five on mixed-methods studies. This scoping review identified various personal (14 articles), interpersonal and social (15 articles), healthcare system-related (9 articles), medication-related (7 articles), and economic (2 articles) factors that facilitate ART adherence among AYAs. Additionally, the scoping review also identified various personal (28 articles), interpersonal and social (13 articles), healthcare system-related (14 articles), medication-related (20 articles), school- or work-related (6 articles), and economic (14 articles) factors that hinder ART adherence among AYAs. Conclusions: Enhancing ART adherence in AYAs requires multiple strategies, including the reduction of internalized stigma, implementation of community awareness campaigns, harm reduction approaches for AYAs who misuse substances, comprehensive education on HIV, and the provision of support from school staff and leadership, alongside the adoption of differentiated service delivery (DSD), which encompasses home-based ART delivery, refills at private pharmacies, community ART distribution centers, and patient-led community ART refill groups, as well as multi-month dispensing practices.