title: Facilitators and barriers to antiretroviral therapy adherence among adolescents in Ghana.
abstract: BACKGROUND
  Adherence to antiretroviral therapy (ART) is known to be challenging among adolescents living with HIV/AIDS, notwithstanding the life-saving importance of this therapy. Of the global total number of adolescents living with HIV in 2013, 83% reside in sub-Saharan Africa. The study aimed to identify facilitators of and barriers to antiretroviral treatment adherence among adolescents in Ghana.
  
  
  METHODS
  A cross-sectional qualitative study using semi-structured interviews for data collection was carried out among adolescents (aged 12-19 years) at the adolescents HIV clinic at the Korle-Bu Teaching Hospital in Ghana. Predominantly open-ended questions relating to ART were used. Interviews were done until saturation. In total, 19 interviews were conducted. Analysis was done manually to maintain proximity with the text.
  
  
  RESULTS
  The main facilitators were support from health care providers, parental support, patient's knowledge of disease and self-motivation, patient's perceived positive outcomes, and dispensed formulation. The identified barriers were patient's forgetfulness to take medicines, perceived stigmatization due to disclosure, financial barriers, and adverse effects of ART. Support from health care workers was the most frequently mentioned facilitator, and patient's forgetfulness and perceived stigmatization after disclosure were the most frequently mentioned barriers. Self-motivation (knowledge induced) to adhere to treatment was a specific facilitator among older adolescents.
  
  
  CONCLUSIONS
  Continuous information provision in addition to unflinching support from health care workers and parents or guardians may improve adherence among adolescents. Also, interventions to reduce patient forgetfulness may be beneficial. A multi-sectorial approach would be needed to address adolescent disclosure of HIV/AIDS status.
authors.affiliation: Pharmacy Department, Korle-Bu Teaching Hospital, Accra, Ghana, Accra, Ghana; Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands, Accra, Ghana.
authors.forename: Daniel Na
authors.initials: DN
authors.lastname: Ankrah
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands, Accra, Ghana.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Koster
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, the Netherlands, Accra, Ghana.
authors.forename: Aukje K
authors.initials: AK
authors.lastname: Mantel-Teeuwisse
authors.affiliation: Noguchi Memorial Institute for Medical Research, University of Ghana (Legon), Accra, Ghana.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Arhinful
authors.affiliation: Health Policy, Planning and Management, University of Ghana School of Public Health, Accra, Ghana.
authors.forename: Irene A
authors.initials: IA
authors.lastname: Agyepong
authors.affiliation: Department of Medicine, University of Ghana Medical School, Accra, Ghana; Department of Medicine and Therapeutics, Korle-Bu Teaching Hospital, Accra, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Lartey
keywords: disclosure; forgetfulness; parental support; qualitative study; stigmatization