Factors Influencing Adherence to Combined Antiretroviral Therapy among HIV-Infected Adolescents in Machakos County, Kenya

Abstract

This study investigated factors influencing adherence to combined antiretroviral therapy (cART) among HIV-infected adolescents in Machakos County, Kenya, using a mixedmethods approach. Quantitative data from structured questionnaires and medical records, along with qualitative data from key informant interviews, were analysed to understand the impact of stigma/discrimination, healthcare factors, social support, and socio-demographic characteristics on adolescents' adherence to cART. The study found that reliable availability of antiretroviral drugs, caregiver support, and a supportive healthcare environment were crucial for maintaining treatment regimens. Financial barriers, transportation costs, and system failures were identified as challenges to adherence. Inferential statistical analysis revealed significant factors affecting adherence: frequency of clinic visits, time to receive medication, and treatment by staff. Frequency of clinic visits showed a negative correlation with adherence probability, indicating that more frequent visits were associated with higher adherence. Surprisingly, a longer time spent at the clinic was positively correlated with adherence, suggesting that more time spent at the clinic may reflect more comprehensive care. Poor treatment by staff negatively impacted adherence highlighting the need for better patient-staff interactions. Social support was also crucial, with 82.8% of respondents having someone accompany them to appointments, 89.4% having support to remember medication, and 97.6% receiving support from the clinic. Most social support came from family members (63.3%), followed by hospital staff (59.5%), with notable dissatisfaction from community (26.8%) and friends (26.8%). Demographic factors, such as age, level of education, living with extended family, and ART regimen, also influenced adherence. Age was negatively associated with adherence, with each additional year decreasing adherence likelihood by 4%. Primary education completion was linked to an 81% higher chance of non-adherence. Living with extended family positively influenced adherence increasing it by 23%. The ART regimen TDF/3TC/DTG was associated with a 28% decrease in adherence compared to ABC/3TC/LPV/r. Recommendations include enhancing support systems, improving healthcare experiences, tailoring interventions, and optimizing clinic visits to address these barriers. In conclusion, addressing determinants such as demographic, clinical, social, and healthcare-related factors can lead to targeted interventions that enhance adherence rates and improve health outcomes for HIV-infected adolescents. The study's findings provide valuable insights for healthcare providers and policymakers to develop strategies that support this vulnerable population in Machakos County and beyond.