Assessment of Factors That Influence Adherence to Antiretroviral Therapy in Adolescents between 10-19 Years Living With HIV Infection in Blantyre Urban
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Date
2022-05-12
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Kamuzu University of Health Sciences
Abstract
The Human immunodeficiency virus (HIV) is one of the significant pandemic of the modern era
which causes Acquired Immunodeficiency Syndrome (AIDS)(1). HIV has affected all countries
globally, and in parts of the world is still a main source of mortality(1). Malawi is geared to ensure
that all necessary HIV and AIDS control measures are implemented with an aim of reducing the
impact of HIV and AIDS and eliminate HIV as a public health threat in 2030 in line with the 2016
United Nations General Assembly Political Declaration on HIV and AIDS(2).
Problem: Despite the tremendous advancement in survival and marked reduction in transmission
through antiretroviral therapy (ART) (3) sub-optimal adherence to ART and poor retention in care
continue to pose a major challenge to the effectiveness of ART, care, and success of HIV treatment
programmes across the world. The treatment failure rate in adolescents living with HIV (ALHIV)
is higher than in adults living with HIV(4). Besides, adolescents are the only age group where
HIV-related mortality is going up (5). Hence, the solution is needed in this susceptible group which
shows a 50% reported increase in AIDS-related mortality, relative to a 30% decline in the general
population (4).
Children and adolescents have lower reported treatment coverage, adherence to treatment and viral
suppression rates than older age groups(6). ALHIV have poorer outcomes than HIV-infected
adults; for instance, delayed initiation of antiretroviral treatment (ART), poorer retention in care
and poorer rates of viral suppression(7). Recent data show an increase in AIDS-related deaths
among the ALHIV, making AIDS the major cause of death in adolescents in SSA and the second
leading cause of death among adolescents internationally(7). However, long term optimal
adherence to ART are essential for sustained viral suppression, thereby preventing drug resistance
and disease progression(8). The recommended optimal adherence to antiretroviral therapy by the
World Health Organisation (WHO) is ≥95%(9). In contrast to WHO’s recommendation, the
average adherence rate to ART among ALHI at Umodzi Family Centre (UFC) which is located
within the campus of Queen Elizabeth Central Hospital (QECH) is equal to 90%, evidenced by the
data-base and ART registers. Given the gap, it is vital to carry out similar studies in Blantyre Urban
in order to determine factors that might be enablers or barriers to optimal adherence to ART among
the ALHIV.
Objectives: The broad objective of this study is to assess the factors that influence adherence to
ART among adolescents between 10-19 years living with HIV in Blantyre Urban. The specific
objectives include the following:
1. To explore health system factors that influence adherence to ART
2. To identify the social-economic factors that may influence adherence to ART
3. To identify socio-cultural factors that maximize adherence to ART.
Methodology
This is a descriptive qualitative study to be conducted in order to assess the factors that influence
adherence to ART among adolescents living with HIV in Blantyre Urban. The In-Depth Interviews
(IDIs) and Focus Group discussions(FGDs) (10) will be used in this study. The former will be used
because it guarantees the deep scope of understanding for social factors (11). The study will be
conducted at Umodzi Family Centre (UFC) within Queen Elizabeth Central Hospital (QECH)
campus in Blantyre. The study population will include all HIV-infected adolescents aged 10-19
whose parents have consented to the study. In this study, data collection tool will include the
pretested interview and discussion guides that will be developed based on the study objectives.
The sample size will be 34 and the study participants will be purposively selected which will
comprise of adolescents for in-depth interviews following the study’s eligibility criteria. The study
will collect data at UFC setting using in depth interviews (IDI) and Key Informant Interviews
(KIIs).
The storage of collected data will be in secured computer data base that have a pass word and only
limited access to key research team will be provided. Data analysis will be done using deductive
and inductive thematic content analysis. Informed consent will be got from each and every study
participant before enrollment in the study. In case of children between the age of 10 -15, caregivers
will sign consent forms on behalf of their children. Each participant will then choose her/his
pseudonym that will be used for the study. Confidentially will be ensured throughout the study
and thereafter. Ethical approval will be sought from the College of Medicine Research and Ethics
Committee (COMREC).
Expected Findings: The findings to be presented will be derived from the answers to research
questions that will be given to the study participants. Evidence will take the form of quotations
from interviews and passages from observations. Critical analysis of the findings and counterevidence
(evidence that contradicts the primary finding) will be done to come up with a logical
presentation of the research findings.
Dissemination of results: Research results will be disseminated in writing and presentations as
feedback made to health care workers at Umodzi Family Centre and the management of Queen
Elizabeth Central Hospital (QECH). Recommendations will be made to various level of decision
makers at QECH and the key implementing partner (Light House) on improvements that need to
be made to understand better the challenges of adherence to ART among adolescents and strategize
appropriate interventions to address challenges and eventually maximize the benefits of
antiretroviral drugs to adolescent patients.
The researcher intends to communicate to overall policy holder, the Department of HIV & AIDS.
The results of my evaluation will be disseminated on the University's website, conferences
organized periodically by the Kamuzu University of Health Sciences (KUHeS) and through
articles published in peer-reviewed journals.
Description
Keywords
Adherence to ART for adolescents in Blantyre