title: High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors.
abstract: Globally adolescents and young adults account for more than 40% of new HIV infections, and HIV-related deaths amongst adolescents increased by 50% from 2005 to 2012. Adherence to antiretroviral therapy (ART) is critical to control viral replication and preserve health; however, there is a paucity of research on adherence amongst the growing population of adolescents living with HIV/AIDS (ALHIV) in Southern Africa. We examined levels of self-reported ART adherence, barriers to adherence, and factors associated with non-adherence amongst ALHIV in Malawi.
  
  
  
  Cross-sectional study of 519 ALHIV (12-18 years) attending two large HIV clinics in central and south-eastern Malawi. Participants self-reported missed doses (past week/month), barriers to adherence, and completed questionnaires on past traumatic events/stressors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Multivariate logistic regression was performed to identify factors independently associated with self-reported ART adherence (7 day recall).
  
  
  
  The mean age of participants (SD) was 14.5 (2) years and 290 (56%) were female. Of the 519 participants, 153 (30%) reported having missed ART doses within the past week, and 234 (45%) in the past month. Commonly reported barriers to adherence included forgetting (39%), travel from home (14%), busy with other things (11%), feeling depressed/overwhelmed (6%), feeling stigmatized by people outside (5%) and within the home (3%). Factors found to be independently associated with missing a dose in the past week were drinking alcohol in the past month (OR 4.96, 95% CI [1.41-17.4]), missed clinic appointment in the past 6 months (OR 2.23, 95% CI [1.43-3.49]), witnessed or experienced violence in the home (OR 1.86, 95% CI [1.08-3.21]), and poor treatment self-efficacy (OR 1.55 95% CI [1.02-2.34]). Sex and age were not associated with adherence.
  
  
  
  In our study, nearly half of all ALHIV reported non-adherence to ART in the past month. Violence in the home or alcohol use in the past year as well as poor treatment self-efficacy were associated with worse adherence. Sub-optimal adherence is a major issue for ALHIV and compromise treatment outcomes. Programmes specifically tailored to address those challenges most pertinent to ALHIV may help improve adherence to ART.
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.|Baylor College of Medicine- Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Maria H
authors.initials: MH
authors.lastname: Kim
authors.affiliation: Baylor College of Medicine- Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Alick C
authors.initials: AC
authors.lastname: Mazenga
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX, USA.|Design and Analysis Core, Baylor-UT Houston Center for AIDS Research, Houston, TX, USA.
authors.forename: Xiaoying
authors.initials: X
authors.lastname: Yu
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.|Baylor College of Medicine- Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmed
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Paul
authors.affiliation: Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, TX, USA.|Baylor College of Medicine- Abbott Fund Children's Clinical Centre of Excellence, Lilongwe, Malawi.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Kazembe
authors.affiliation: ICAP, Mailman School of Public Health and College of Physicians & Surgeons, Columbia University, New York, NY, USA.
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008295:Malawi; D008297:Male; D057566:Self Report; D013240:Stereotyping; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Antiretroviral therapy; HIV; adherence; adolescents; alcohol; self-efficacy; sub-Saharan Africa; violence