title: Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. dnyogea@ihi.or.tz.|Swiss Tropical and Public Health Institute, Basel, Switzerland. dnyogea@ihi.or.tz.
authors: Daniel
authors: D
authors: Nyogea
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. smtenga@ihi.or.tz.
authors: Sally
authors: S
authors: Mtenga
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. lhenning@idi.co.ug.|Swiss Tropical and Public Health Institute, Basel, Switzerland. lhenning@idi.co.ug.|University Hospital of Zurich, Zürich, Switzerland. lhenning@idi.co.ug.
authors: Lars
authors: L
authors: Henning
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. fabian@ggaweb.ch.|Swiss Tropical and Public Health Institute, Basel, Switzerland. fabian@ggaweb.ch.
authors: Fabian C
authors: FC
authors: Franzeck
authors: Swiss Tropical and Public Health Institute, Basel, Switzerland. Tracy.Glass@unibas.ch.
authors: Tracy R
authors: TR
authors: Glass
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. emili.letang@unibas.ch.|Swiss Tropical and Public Health Institute, Basel, Switzerland. emili.letang@unibas.ch.|ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain. emili.letang@unibas.ch.
authors: Emilio
authors: E
authors: Letang
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. Marcel.Tanner@unibas.ch.|Swiss Tropical and Public Health Institute, Basel, Switzerland. Marcel.Tanner@unibas.ch.
authors: Marcel
authors: M
authors: Tanner
authors: Ifakara Health institute, P.O Box 153, Ifakara, Tanzania. egeubbels@ihi.or.tz.
authors: Eveline
authors: E
authors: Geubbels
mesh_terms: D000293:Adolescent; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D036301:Qualitative Research; D012423:Rural Health; D013636:Tanzania; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents
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