Effect of Peer Support Intervention on Adherence to Anti Retroviral Therapy Among HIV-Positive Youths in Two Districts in the Ashanti Region, Ghana.

Abstract

Background: Adherence to treatment in chronic diseases is a major challenge, particularly in HIV treatment and management, because Anti-Retrovirals (ARVs) are needed over a lifetime. Non-adherence to treatment is especially common among youth (15-24 years) living with HIV, with global and national evidence consistently showing lower adherence rates. Suboptimal adherence rates limit treatment effectiveness, increase the risk of disease transmission, increase morbidity and mortality, and undermine global HIV control efforts. There is limited evidence on strategies to improve adherence to ARV use among young people. This study assessed the effect of a peer support intervention on adherence to anti-retroviral therapy among young people living with HIV in Ghana. Method: A quasi-experimental study involving a control and intervention arm was conducted among 228 youths aged 15-24 years diagnosed with HIV. Study participants were recruited from Anti-Retroviral Therapy (ART) clinics from two district hospitals in the Ashanti region, Ghana. With the support of clinic staff, HIV-positive peers were trained to deliver the study intervention. Participants from the intervention group received treatment support from their trained peers including a monthly home visit, daily Short Message Service (SMS) reminders on taking their medication, phone call reminders for scheduled clinic appointments, and monthly support group meetings in addition to HIV standard of care. The control group received the standard of care from the ART clinic as per the Ghana Health Service guidelines for the treatment and management of HIV. The primary outcome of the study, adherence, was measured using the Morisky medication adherence scale (MMAS-8) and complemented by the pill count method at enrolment and six (6) months after the intervention. In addition, data on participant’s demographic and clinical characteristics, depressive state, stigma, disclosure, and viral load (from medical records) were obtained. Focus group discussions were conducted to explore the experience of participants on their involvement in the intervention. Results: At pre-intervention, there was no significant difference in adherence levels (71.9% vs.70.2% by MMAS-8, 62.3% vs. 64.9% by pill count), depression state (31.6 % vs. 29.0%), internal stigma score (12.61 vs. 13.04), HIV disclosure (43.0% vs. 41.2%), and viral suppression (64.7% vs. 62.2%) between the intervention and control groups respectively. A difference-in-differences analysis showed that at post-intervention, the intervention group showed a significant improvement in ART adherence [change in MMAS-8: 19.1% (95% CI: 2.8, 35.4), change in Pill count: 30.2% (95% CI: 13.0, 47.4)]. Prevalence of depression state decreased significantly in the intervention group (-26.1%, 95% CI: -42.6, -9.6), while internal stigma also showed a significant reduction of 2.61 (95% CI: -3.85, -1.35) percentage points. HIV disclosure and viral suppression improved slightly among the intervention group but were not statistically significant (p>0.05). Conclusions: The peer support intervention was effective in improving adherence to ART, reduced depression and internal stigma among youths living with HIV. However, the intervention had no significant effect on HIV disclosure or viral suppression. These findings suggest that peer support intervention can be a valuable approach for enhancing ART adherence and addressing psychosocial challenges, such as depression and stigma among youths living with HIV. Additional strategies such as sustained adherence monitoring, prolonged intervention duration, and/or more frequent counselling may be required to achieve viral suppression and promote disclosure behaviours.