Adherence to antiretroviral therapy among adolescents living with HIV in Jamaica

Objective: To characterize adherence patterns to antiretroviral therapy (ART) and identify factors affecting optimal adherence among adolescents living with HIV (ALHIV) in Kingston, Jamaica during the Covid-19 pandemic. Design: and Methods: During August-October 2021, we conducted a cross-sectional study on adherence (no missed doses in preceding four days) among adolescents 10-18 years attending three outpatient departments in the Kingston Metropolitan Area. Adherence factors were evaluated using a self-administered, interviewer-assisted structured questionnaire. Biochemical and clinicopathological information were retrieved from patients’ medical records. Multivariate logistic regression was used to determine likelihood of adherence for given adherence factors. Results: : Of 65 participating clients, 92.3 % were perinatally infected, mean (SD) age 15.4 (2.0) years and 61.5% were female. Overall self-reported adherence was 66.1% (43/65) and higher among adolescents in residential care versus family care (p=0.002). Median (IQR) viral load 19 copies/ml/10 3 (IQR 19-51) was lower (p=0.010) and median (IQR) CD4 + count 701 cells per µL (IQR 501-1052) higher (p= 0.016) among adolescents in residential care compared to family care. Adherence was 4 times more likely among adolescents at UHWI (OR=4.53, 95% CI (1.25, 16.43), knowledgeable about ARVs (OR= 4.31, (1.09,17.04), and with reduced appointments due to Covid-19 pandemic (OR= 5.36, (1.09, 26.41) and 4 times less likely if cared for by relatives, experiencing side effects, higher pill burden or hospitalized with complications. Conclusions: : Medication, caregiver-related and health system management factors are both enablers and barriers of adherence for ALHIV, and the importance of caregivers’ support, treatment literacy and simplified treatment regimens are highlighted.