Exploration of adherence to antiretroviral treatment amongst adolescents in a low socio-economic urban setting in Cape Town, South Africa
Background: HIV has reached epidemic proportions globally with Sub-Saharan Africa carrying the greatest burden (71%). It is estimated that there are 37 million people world-wide infected with HIV, and an estimated 6.8 million live in South Africa. Globally there were 2.1 million adolescents living with HIV in 2014. Improved access to Antiretrotiviral Therapy (ART) has led to a steep decline in HIV incidence and HIV-related mortality. Yet despite these successes in terms of HIV treatment outcomes, HIV-related mortality amongst adolescents has increased. Adolescents are defined by the WHO as individuals between 10 and 19 years old. WHO states that adolescents have poorer access to ART, are at a higher risk of disengaging from care and have special needs to keep them motivated to remain in care. The uptake of adolescents into the South African ART programme is low and those that are enrolled into the programme have poorer adherence than their adult counterparts. Aim: The aim of the study was to explore the factors that influence adherence to ART amongst adolescents in a primary health care clinic in a low socio-economic, urban setting in Cape Town. Methodology: An exploratory qualitative design was employed where data was collected through two key informant interviews with staff from an urban primary health care clinic. Four focus group discussions and eight individual in-depth interviews were held with adolescents and young people who accessed ART at this health facility. Audio data was digitally recorded and transcribed verbatim. Data was analyzed using content analysis. Results: The study identified school commitments, strained teacher-pupil relationships, negative household dynamics and ill-treatment by non-biological caregivers as major reported barriers to adherence. In addition, poor service delivery, missing and misplaced files and long waiting times came under major criticism. Fear of intended or unintended disclosure of HIV status, perceived stigma and discrimination, treatment fatigue and having unstructured lives, profoundly influenced ART adherence. Finally, having a strong support system, disclosing to a trustworthy person and having goals and ambitions served as motivators to remain adherent to ART. Conclusions: This study highlighted the complexity of ART adherence amongst this age group due to school factors, social factors, health services factors, therapy related factors and patient factors. Interventions to improve adherence should aim to address treatment fatigue, disclosure, household dynamics, service delivery factors, as well as the impact of school commitments and symptoms of depression on ART adherence amongst adolescents.