Determinants of Adherence to HIV Treatment Amongst Adolescents Living with HIV/Aids in Two Hospitals in the Southwest Region

Naiza Monono¹^,²*, Nga Ndongo Bella¹, Verla Vincent¹, Evelyne Mah³, Gregory-Edie Halle^1,4

¹Department of Internal Medicine and Paediatrics, University of Buea, Cameroon
²Regional Hospital Limbe, Southwest Region, Cameroon
³Department of Clinical Sciences, University of Garoua, Cameroon
⁴Dean, Faculty of Health Sciences, University of Buea, Cameroon

*Corresponding author: Naiza Monono, Department of Internal Medicine and Paediatrics, University of Buea, Cameroon and Regional Hospital Limbe, Southwest Region, Cameroon; Email: docnaiza@gmail.com

Citation: Monono N, et al. Determinants of Adherence to HIV Treatment Amongst Adolescents Living with HIV/Aids in Two Hospitals in the Southwest Region. J Pediatric Adv Res. 2025;4(2):1-8.

Copyright^© 2025 by Monono N, et al. All rights reserved. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Table 1: Description of socio-demographic characteristics of adolescents.

Proportion of Adherent Participants Who Reported Good Adherence with Pill Count Method

Amongst these adolescents, 52.1% of the participants presented good adherence using the pill count formular method, as seen on Table 2.

Table 2: Proportion of adolescents who reported good adherence with pill count method.

Proportion of Adherent Participants Using Self Report Adherence Method

Amongst the participants, 58% of them were adherent to ART using the self-report adherence method as shown on Fig. 1.

Figure 1: Proportion of adolescents who reported good adherence using the self-report method.

Description of Psychosocial, Medication Related and Health Care Related Factors of Adherence

With respect to the psychological lifestyle of these adolescents, we found that 137(63.1%) of the participants felt they had a closed relationship with their family and friends who provided emotional security and well-being. It was also found that 150(69.1 %) of them had been stigmatized before and lastly, 194 (89.4%) of the adolescents felt lonely or discouraged. With regards to medication, 151 (69.6%) of them said their family encouraged and reminded them of when to take their drugs. It was found that 198 (91.2%) of them believed that their medications kept them healthy. Also, 195 (89.9%) of the participants said the side effects of the drugs were very minimal. Among the health care related factors, 207 (95.4%) of the participants trusted the service provider, 197 (90.8%) said the health providers were welcoming and encouraging. We had 158(72.8%) who received moral and social support from the personnel and 195(89.9%) revealed the personnel gave patients adequate information concerning the drug and state of health.

Bivariate Analysis of Determinants of Adherence

On bivariate analysis, adolescents aged 10-14years (p= 0.03) and those who were students (p=0.04) were found to be significantly associated with adherence to ARV. Among the medication-related factors, having a family who encouraged and reminded of when to take the drug (p=0.000), having a particular time to take drugs (p=0.000), having the belief that the drug kept them healthy (p=0.001), consistency of food to eat (p=0.001) and having minimal drug side effect (p=0.004) were all statistically significant to adherence. Trusting the services provided (p=0.015), receiving information given by health care providers on their state of health and medication (p=0.002) and the fact that participants received moral support from the health personnel (p=0.002) were all statistically significant respectively. Feeling supported by family and friends (p=0.000) and feeling comfortable to talk about worries with families (p=0.000) were also all significantly associated with adherence.

Multivariate Analysis of Determinants of Adherence

After the logistic regression analysis, adolescents aged 10- 14 years was found to be 3 times more likely to have good level of adherence when compared to those aged 15-19 years (AOR: 3.3, p=0.021 CI:1.202-9.060). Participants who felt comfortable talking to their families about their worries were 4 times more likely to have good adherence when as compared to those who did not (AOR: 3.6, p=0.002 CI: 1.598-8.421) as shown in Table 3.

Table 3: Sociodemographic and Psychosocial determinants of ART adherence among adolescents living with HIV.

Participants who had a particular time at which they took their drugs were 9 times more likely to have a good level of adherence when compared to those who did not (AOR = 9.171, p=0.008 95%CI: 1.781-47.221) as in Table 4.

Table 4: Medication-related determinants of ART adherence among adolescents living with HIV.

Discussion

Our study revealed that out of 217 participants, there were more girls 111 (51.2%) than boys with a ratio of 1.05 :1. This can be since girls are more vulnerable than boys because of biological reasons (greater mucus area exposed to HIV during penile penetration) and they are also exposed to transactional relationships. The results of this study as far as the proportion of HIV in adolescent girls was coherent with Tanyi, et al., (54.9%) in Kenya, Habumugisha, et al., (54%) in Rwanda and Ketchaji, et al., in Yaounde (55%) [7,9,10]. It was however lower than 63% by Nabukeera-Barungi, et al., in Uganda [11]. In contrast, Ugwu, et al., found out there were more boy affected (51.2%) [12]. This is probably because we had 69.1% of the participants included in the study were in the age group of 15-19 years, with a particularity that this age group may be in a “critical exposure period’’ in determining lifetime HIV risk since in this period, sexual behaviour patterns are formed. This was higher than a similar study made in Yaounde by Ketchaji, et al., (61.9%) [9]. It was noticed that 53.5% of the participants had reached secondary level of education. This can be because the research was carried out in a semi-urban area, where parents must try to educate their children. This was similar to the findings by Ketchaji, et al., in Yaounde who had 57% [9].

Adherence by pill count was 52.1%. This was significantly low as compared to the standard 95% optimal adherence accepted. This value was higher than 38.2% of Ketchaji, et al. [9]. It can be because many strategies have been developed to increase the level of adherence among these target group.

Our study also found out that only 58% of our participants were adherent following self-report adherence measurement. This could be because the responses are based on patient’s recall memory for the past 30 days so there is a bias. This value was lower than the 60.6% from Ketchaji, et al., and 82.9% from Bongfen, et al. [8,9]. The lower adherence percentage could be because of other adherent strategies that have been put in place by these bigger centers of care and follow up.

Having close relationships with family and friends was significantly related with adherence This was like findings by Ugwu, et al., in Nigeria and by Damulira, et al., in Uganda [12,14]. This could be explained by the fact that the family might have HIV-related knowledge so, the importance maintaining good medication adherence is of priority [13]. Feeling of having family who provides emotional support was also significantly related with adherence. Perception of a supportive family environment in the form of receiving emotional support is likely to decrease negative effects associated with the disease, probably by increasing self-esteem and adaptive coping. However, after multivariate analysis it was found out that age was significantly associated with adherence. Adolescents of age group within 10-14 years were 9 times more adherent compared to the other group of adolescents. This can be since this age group mostly depend on their caregivers. Adolescents of this group may generally see things as good or wrong without much room in between so they need a good support from carers, which might be the case in our study. This contrasted with the findings by Lantche, et al., in Yaounde who did not find any association between age and adherence [15].

Feeling comfortable to talk about worries to the family was found to increase occurrence of adherence. This could be because in Sub-Saharan Africa, families rely on close network of kinship members for loyalty and support among members. Also, cohesive families will know the HIV status of the adolescents in the family and hence more likely to encourage them and remind them of when to take their drugs. This was seen in a similar study by Damulira, et al., in Uganda [14]. Having the same time at which the medication is taken was statistically significant. This was also found by Ketchaji, et al., in Yaounde [9]. This might be because of their effective memory techniques such as alarms clocks or the support from family members.

Having minimal side effects of the medications, believing the medication keeps healthy and presence of food when drug is to be taken and they were found to be significantly associated with adherence. This was like the findings of Habumugisha, et al., (patients see ART as good and they did not contract other illnesses since they began taking them consistently) [10]. Also, trusting the services by the providers, receiving moral and social support from the health care providers, the personnel are welcoming and encouraging and trusting the information from the personel on the drug and state of health. But all these significant determinants were not associated with adherence on multivariate analysis.

Conclusion

We can conclude that: 58% and 52.1% of adolescents were adherent to their medication with respect to self-report and pill count measurement respectively which means adherence is still sub- optimal in the Southwest region. Factors favouring adherence of these adolescents were related to a particular age group, the aspect of talking comfortably to family and a precise time for drug intake.

Conflict of Interests

The authors declare that they have no conflicts of interest.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial or non-profit sectors.

Acknowledgments

The authors would like to thank the research assistants for data extraction and statistical analysis and all the adolescents who participated in this study.

Author Contributions

All authors participated in the design and review of this article; HVM and AB jointly wrote the manuscript.

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