Teenage adherence to ART

This week a number of issues were presented at the Zimbabwe HIV and Aids conference, under the theme “Eliminate New HIV infections – Keep Mothers Alive”.

HIV and Aids affect a significant part of society today, particularly the youth.

One presentation highlighting factors associated with adherence to anti-retroviral therapy (ART) among adolescents attending three clinics in Harare also showed that even though treatment is being offered, there are issues of adherence to consider.

Adherence is the taking of medication, particularly, prescribed anti-retroviral drugs (ARVs), tuberculosis drugs (TB treatment mentioned because of its common coexistence with HIV infection) or cotrimoxazole prophylaxis which is given to HIV-infected people to prevent the development of opportunistic infection.

Findings have shown that ART reduces infection rate by 90%+, contributing to the well-being of any infected person.

The concern, however, is that some young people are defaulting, by not taking this treatment for various reasons.

These are namely factors of social support and depression; treatment regimen side effects of the drug and pill burden; trust and confidence in the healthcare provider; clinical settings, education — about the virus, the drugs and finally support.

Dr L Takundwa from the National Aids Council and Master in Public Health Programme at the University of Zimbabwe presentation on this adherence topic, having conducted research using a sample of about 330 participants, 51,9% of which were female, with an average age of 16 years.

The study looked at three hospitals offering ART to adolescents — Harare Central Hospital, Beatrice Infectious Diseases Hospital and Wilkins Hospital.

Currently in Zimbabwe over 100 000 adolescents are registered with HIV care services, whose adherence is dependent on these caregivers, Takundwa said.

Some of the findings showed that the frequency of missed doses was because the adolescents were busy with other things or were away from home at the time they needed to take the treatment.

Orphanhood was also a notable barrier to adherence to ART. According to Africaid (an organisation helping HIV-positive children and teenagers to enhance their psychological, emotional and social well-being), the reason for this is the change in households, moving in of one family member after another.

This brings in the issue of disclosure because such young people may find it difficult to disclose their status to a family member for fear of rejection and stigmatisation.

Another concern is that these adolescents are simply tired of taking the medication. This treatment has to be administered daily several times a day and this can be burdensome.

On a positive note, those who had attended secondary school were more likely to adhere to treatment, illustrating that education does have a role to play in society and development.

Likewise being on ART for more than 24 months was a significant facilitator to adherence, because one would have seen the benefits of the treatment to their health.

The travel allowance to clinics and being treated with respect were important to these teenagers.

Sometimes there is the temptation for “adults” to lecture and chastise adolescents, making it difficult for them to feel comfortable and reach out for care, so being respected at the centres helps adolescents see the positive aspects of the treatment.

In addition one unexpected observation made from the study showed that being well-informed about HIV and ART was not necessarily a guarantee for adherence.
This means that stakeholders need to find innovative ways to encourage testing, disclosure and adherence to ART.

Recommendations were made for the training of healthcare workers, social support systems and training of peers to facilitate healthcare.

This training and way forward should be formed on the basis of trust and respect for the teenagers.

Adolescents need to know their matter will be treated in confidence.

One representative from a youth organisation in the plenary session also urged stakeholders and “adults” to offer friendly centres and support to young people.

Adolescents living with HIV should therefore be encouraged to adhere to ART, to live longer, healthier and fulfilled lives. Let’s keep our youth alive!

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