Department of Population, Family and Reproductive Health
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Item Determinants of Adherence and Treatment Outcomes Among Adolescents Living with HIV in Cameroon(University of Ghana, 2019-07) Bongfen, M.C.Background: Despite over three decades of HIV, its prevalence especially among adolescents remains a public health concern. In 2015, there were more than two million adolescents living with HIV, with a higher proportion coming from sub-Sahara Africa. In Cameroon, there are over 40,000 adolescents living with HIV and there are still concerns about the provision of care to them as adolescents are trapped between paediatric and adult services which are unable to address their specific needs. However, there are limited studies in Cameroon that have examined adherence to antiretroviral treatment and associated factors as well as treatment outcomes among adolescents. It is therefore essential to clearly understand the determinants of adherence of these adolescents and their treatment outcomes. Objectives: The main objective of the study was to assess the determinants of adherence to Anti-Retroviral Therapy and treatment outcomes among adolescents living with HIV in Cameroon. Methods: The study was an analytical cross-sectional Study with a record review component. A total of 460 respondents were recruited from nine health facilities. A systematic random sampling procedure was used to select the required participants. Pretested questionnaires were administered to participants to collect data. The main outcome of interest (adherence) was measured in two ways: self-report adherence, and medication possession ratio (MPR). Three treatment outcome measures that were assessed included viral load suppression, retention in treatment, and CD4 counts. Finally, health facility readiness towards care for adolescents on ARV was assessed using the John Snow Inc. (JSI) tool. Descriptive (frequencies and proportions) and inferential (chi square and multivariate logistic regression) statistical analyses methods were used to analyse the data. Statistical significance was set at p<0.05 at a 95% confidence level. Results: A total of 455 questionnaires were retained and this gave a response rate of 99%. The average age of the adolescents was 14.8years (SD= ±2.9years). There were more females (55%) than males (45%) in the study. A larger proportion of the respondents were on first line treatment (77%) and had been on treatment for an average of five years. Self report adherence was 83% while MPR was 73%. The difference in adherence between self report and the Medication Possession ratio was not statistically significant (p=0.97). Regarding the determinants of adherence, 12 out of 30 independent variables examined showed significant statistical association with adherence at the bivariate level. In multivariable logistic regression analyses however, only two variables significantly predicted adherence, namely experiencing side effects (AOR= 2.63; 95%CI=1.14, 6.09; p = 0.02) and internalized stigma (AOR=2.51; 95%CI =1.04, 6.04; P = 0.04). The major challenges to adherence were stigma (59%) and forgetfulness to take medications (59%) while sending reminder messages and having friendlier health providers were the main suggestions to help improve on adherence. In terms of treatment outcomes, 70% of the respondents had their viral load suppressed. The retention rates were observed to decrease over time: 88%, 72% and 58% at 6months, 12 months and 24 months respectively. All the selected facilities were shown to be ready to receive adolescents into treatment as 7 out of the 9 facilities were in stage 5 of the facility readiness assessment. Conclusion: The determinants of adherence among adolescents are more psychological than the physical characteristics that differentiate them. There is therefore a need for more individual-targeted counselling for adolescents and their guardians to improve adherence levels among adolescents on antiretroviral treatment.