Abstract:
Lower levels of adherence to antiretroviral therapy (ART) among older adolescents as compared to
adults are influenced by individual, psychosocial, and treatment-related factors. Successful transition
of older adolescents into HIV adult care from paediatric & adolescent focused care requires an
understanding of barriers to ART adherence. This study aimed at determining individual factors
affecting ART adherence among older HIV positive adolescents transitioning to adult care. Between
December 2018 and January 2019, we conducted a cross-sectional study among 82 perinatally infected
adolescents aged 16-19 years in an HIV care and treatment clinic in Nairobi, Kenya. We used completed
structured questionnaires and abstracted data from clinical charts. We performed multivariate logistic
regression to identify factors independently associated >95% self-reported ART adherence (7-day
recall). The study participants had a median age of 17 (IQR 16,18) on ART for a median duration of 11
years (IQR 7,13). Sixty-four per cent (52) of the adolescents reported optimal adherence was of >95%,
and 15% reported missing doses for three or more months. Self -reported adherence had a high
correlation with viral loads of <1000 copies ml (Kappa= 0.087). Adolescents with high self-efficacy were
eight times more likely to report adherence of >95% [OR 8.1, 95% CI (2.31- 28.18)]. Once a day, dosing
was also independently associated with adherence [OR 1.58, 95 %CI [0.62-4.08].
Conclusions: The reduction of ART pill burden and the inclusion of assessment of ART self –efficacy
may contribute to transition preparedness among adolescents..
