title: Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda.
abstract: BACKGROUND
  Adolescents have gained increased attention because they are the only age group where HIV related mortality is going up. We set out to describe the level and factors associated with adherence to antiretroviral therapy (ART) as well as the 1 year retention in care among adolescents in 10 representative districts in Uganda. In addition, we explored the barriers and facilitators of adherence to ART among adolescents.
  
  
  METHODS
  The study involved 30 health facilities from 10 representative districts in Uganda. We employed both qualitative and quantitative data collection methods in convergent design. The former involved Focus group discussions with adolescents living with HIV, Key informant interviews with various stakeholders and in depth interviews with adolescents. The quantitative involved using retrospective records review to extract the last recorded adherence level from all adolescents who were active in HIV care. Factors associated with adherence were extracted from the ART cards. For the 1 year retention in care, we searched the hospital records of all adolescents in the 30 facilities who had started ART 1 year before the study to find out how many were still in care.
  
  
  RESULTS
  Out of 1824 adolescents who were active on ART, 90.4 % (N = 1588) had ≥95 % adherence recorded on their ART cards at their last clinic visit. Only location in rural health facilities was independently associated with poor adherence to ART (P = 0.008, OR 2.64 [1.28 5.43]). Of the 156 adolescents who started ART, 90 % (N = 141) were still active in care 1 year later. Stigma, discrimination and disclosure issues were the most outstanding of all barriers to adherence. Other barriers included poverty, fatigue, side effects, pill burden, depression among others. Facilitators of adherence mainly included peer support groups, counseling, supportive health care workers, short waiting time and provision of food and transport.
  
  
  CONCLUSIONS
  Adherence to ART was good among adolescents. Being in rural areas was associated with poor adherence to ART and 1 year retention in care was very good among adolescents who were newly started on ART. Stigma and disclosure issues continue to be the main barriers to adherence among adolescents.
authors.affiliation: Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, P O Box 7062, Kampala, Uganda. nicolettebarungi@yahoo.com.
authors.forename: Nicolette
authors.initials: N
authors.lastname: Nabukeera-Barungi
authors.affiliation: AIDS Control Program, Ministry of Health, Kampala, Uganda. ellypj@yahoo.co.uk.
authors.forename: Peter
authors.initials: P
authors.lastname: Elyanu
authors.affiliation: AIDS Control Program, Ministry of Health, Kampala, Uganda. barbaraasire@yahoo.com.
authors.forename: Barbara
authors.initials: B
authors.lastname: Asire
authors.affiliation: AIDS Control Program, Ministry of Health, Kampala, Uganda. ckatureebe@urc-chs.com.
authors.forename: Cordelia
authors.initials: C
authors.lastname: Katureebe
authors.affiliation: AIDS Control Program, Ministry of Health, Kampala, Uganda. luanzag@gmail.com.
authors.forename: Ivan
authors.initials: I
authors.lastname: Lukabwe
authors.affiliation: AIDS Control Program, Ministry of Health, Kampala, Uganda. eleanormagongo@gmail.com.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Namusoke
authors.affiliation: AIDS Control Program, Ministry of Health, Kampala, Uganda. jmusinguzi@infocom.co.ug.
authors.forename: Joshua
authors.initials: J
authors.lastname: Musinguzi
authors.affiliation: Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. atuyambe@musph.ac.ug.
authors.forename: Lynn
authors.initials: L
authors.lastname: Atuyambe
authors.affiliation: USAID SUSTAIN Project, University Research Co., LLC, Kampala, Uganda. ntumwesigye@gmail.com.
authors.forename: Nathan
authors.initials: N
authors.lastname: Tumwesigye
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology; D001294:Attitude to Health; D002648:Child; D003376:Counseling / Q000379:methods; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D006282:Health Personnel; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011203:Poverty; D012189:Retrospective Studies; D012424:Rural Population; D012944:Social Support; D014454:Uganda; D016903:Drug Monitoring