Kim, M.H., Mazenga, A.C., Yu, X., et al. Journal of the International AIDS Society (March 2017), 20(1):1–12, doi:10.7448/IAS.20.1.21437.
Reaching 90-90-90 goals will be impossible without addressing HIV in adolescents and young adults, who account for more than 40 percent of new HIV infections. However, there is a paucity of research on adherence among adolescents living with HIV (ALHIV) in Southern Africa. This cross-sectional study examined antiretroviral therapy (ART) adherence, barriers to adherence, and factors associated with non-adherence among ALHIV in Malawi. ALHIV attending two large HIV clinics self-reported missed doses (past week or month) and barriers to adherence, and completed questionnaires on stress factors, disclosure, depression, substance use, treatment self-efficacy, and social support. Biomedical data were retrieved from existing medical records. Of the 519 participants, nearly half reported non-adherence to ART: 153 (30%) within the past week, and 234 (45%) in the past month. The most frequently self-reported barriers to adherence were forgetting (39%), travel from home (14%), and being busy with other things (11%). Analysis revealed several factors that were independently associated with missing a dose in the past week: drinking alcohol in the past month, missing a clinic appointment in the past six months, witnessing or experiencing violence in the home, and poor treatment self-efficacy. Suboptimal adherence, the authors concluded, is a major issue for ALHIV that urgently requires strong, tailored interventions to meet the needs of this key risk group.