Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study

BMC Infectious Diseases

Eveline Geubbels⁴  Marcel Tanner³  Emilio Letang²  Tracy R Glass³  Fabian C Franzeck³  Lars Henning¹  Sally Mtenga⁴  Daniel Nyogea³ 

[1] University Hospital of Zurich, Zürich, Switzerland;ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain;Swiss Tropical and Public Health Institute, Basel, Switzerland;Ifakara Health institute, Ifakara, Tanzania

关键词: In-depth interviews;    Focus group discussions;    Non-parental caretaker;    Pill count;    Teenagers;    Children;    ART adherence;   

Others  :  1109742
DOI  :  10.1186/s12879-015-0753-y

 received in 2014-09-06, accepted in 2015-01-13,  发布年份 2015

【 摘 要 】

Background

Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan Africa. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART adherence among children and teenagers in rural Tanzania.

Methods

We applied a sequential explanatory mixed method design targeting children and teenagers aged 2–19 years residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining focus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined optimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic regression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored issues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was analysed using thematic content analysis.

Results

Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the average adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the qualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity, being unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and forgetfulness were seen to be barriers for optimal adherence.

Conclusion

The study has highlighted specific challenges in ART adherence faced by children and teenagers. Having a biological parent as a caretaker remains a key determinant of adherence among children and teenagers. To achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system need to be designed.

【 授权许可】

   
2015 Nyogea et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

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