Abstract

Antiretroviral therapy is used to suppress the HIV viral load but requires optimal adherence to be effective. This study examined the factors influencing the adherence to ART among HIV positive clients (adolescents)at the Regional hospital Buea. A cross sectional design was adopted among 100 HIV  clients aged 10-19years. Questionnaires were the instruments for data collection .

Data analysis were done using statistical package for social sciences (SPSS) and presentation were done using charts and graphs. In the study, it was found that 59(59%)  take their medication twice and 22(33.9 %) stated they forgot to take their medication making them non- adherence .

92 % had adequate knowledge on the importance of ART while 8% had inadequate knowledge on ART. 49% knew their status when they were not feeling fine and 4% knew after the death of their mother. Psychological support from family and friends(100%) is a major promoting factor to ART.

The lack of psychological support (100%) as an inhibiting factor to ART adherence. ARV consumption education should be enhanced among HIV positive clients at the community health center to ensure that clients are well aware of the dangers associated with the non- adherence of ARVs. Interventions should focus on increasing clients confidence in adhering to ART. Health care providers should be empowered to provide reminders to patients such as phone calls.

CHAPTER ONE

INTRODUCTION

 1.1 Background to the study

Adherence to ARV therapy is fundamental in the achievement of the millennium development goal 6 which is; to combat HIV/AIDS, Malaria and other diseases ( Nwonwu ,2008) . A healthy community is vital for social -economic development. In recent years, considerable resources and Human immunodeficiency virus [HIV] continues to be a major global public health issue.

In 2018 an estimated 37.9million people were living with HIV with 1.7million children, with a global HIV prevalence of 0.8% among adults. In 2018, 770.000 people died of AIDS related illness. [AIDS research and therapy,2018]. The vast majority of people with HIV are located in the middle income countries with estimated 68% in sub-Sharan Africa [UNAIDS, 2018].

money have been invested so as to achieve universal access to ARV therapy. Countries striving to expand treatment access have set goals of providing antiretroviral treatment to 80% of those infected. This has not yet been achieved as the current global coverage is 65% . The target has yet to be released due to factors associated with lack of ARV therapy adherence (Volberding, 2008)

In 2018 worldwide, 1.65million adolescent were living with HIV and an estimated 190.000 were newly infected with HIV. This situation is especially for girls who account for 7.4% of the adolescents acquiring HIV[adolescent health ;WHO 2018]. In 2017, among 40 countries with available data ,43% of adolescent living with HIV were receiving antiretroviral therapy [ART] had viral suppression than adults [UNAIDS,2019]. Cameroon like most Sub-Sharan Africa is facing a generalized increase in HIV pandemic. Estimated number of adolescents living with HIV in Cameroon is 3900[2%} of the total number in Sub-Sharan Africa with dead rate of 1200[2%] as compared to 85%  in  Africa (UNAIDS,2013).

Adolescent 10-19years old comprise one sixth of the world’s population. Almost 90% of them live in low- and middle-Income countries to which Cameroon is included where access to health and social services maybe limited for myriad reasons. Since the number of adolescent is expected to rise significantly through 2050, achieving the sustainable development goal , including the targets for universal health coverage requires addressing their unique needs ( UNAIDS, 2019).

In Cameroon in 2018 , 540.000 people were living with HIV ( UNAIDS ,2019). The national AIDS control committee/ central technical group ( CNLS/GTC) estimates that there are 141 new infections per day in Cameroon , which means six newly infected persons each hour every day . The main mode of HIV infection in Cameroon is through sexual intercourse. About 90% of new infections are estimated to occur as a results off unprotected sexual relations. Multiple sex partners and non-use of condom increases the risk of infection (Denise and Lenora ,2013) especially in adolescents who are sexually very active , have poorly developed life skills and are unable to negotiate sex.

HIV and AIDS critically affects Cameroon’s social and economic development. Regarding the health sector there is also increase demand for qualified health professionals who care for AIDS patients and supports the national treatment program especially towards adolescents who are more sexually adolescents living with HIV ( ALWHIV). Health care professionals must be alert to the high prevalence of low adherence to treatment during adolescence. Low adherence increases morbidity and medical complication, contributes to poorer quality of life and over the health service. So the competence and practices of counseling are very vital for optimal adherence in adolescents.

Every client seeking care including the ALWHIV comes from a cultural and socioeconomic background. Each of these has element that needs to be diagnosed in order to provide care in a manner that is seriously conflicting with the client’s cultural and socioeconomic status. Sometimes in the provision of care especially in counseling ,conflicting ideas need negotiation and sometimes patterning but these must be done in an acceptable manner such that the client (adolescent) is at ease and so adherence to treatment is enhance. For this to occur the competence and practice of the care provider plays a vital role ( Mary Bisuh et al, 2016)

Human Immunodeficiency virus (HIV) is the leading cause of global burden disease. A key goal to ART is to suppress viral replication. The  World Health Organization (WHO) introduced viral load monitoring as a gold standard to follow-up the treatment effectiveness in 2013( Kolab and Gitau 2018). UNAIDS adopted the 90- 90 -90 target to help end the AIDS epidemic.

That is , 90%  of all people living with HIV will know their status , 90% of all people with diagnosed HIV infection will receive sustained ART and 90% of all people receiving ART will have a suppression by 2020. Universal test and treat (UTT) is a recommendation made in 2015 by WHO to initiate ART in all positive patients irrespective of their CD4 count. This recommendation was put in place, based on a systematic view, with two important aim; to prevent HIV-related morbidity through earlier initiation of ART , and to prevent sexual transmission of HIV by achieving and maintaining viral suppression .

In 2015, adolescents represented the fastest growing age group of people living with HIV (PLWHIV) accounting for 5.9% of the burden of HIV. This underscores the need for greater understanding and suitable adaptation of HIV care and treatment service. Sustaining optimal ART adherence in adolescents and young adults living with HIV (AYLWHIV) has emerged as a major health care challenges, fundamentally due to regimen complexity and adherence efficacy ( Southern African HIV clinicians society 2017).

While new infections among children globally have also declined from 280.000 in 2010 to 160.00 in 2018. A 41% reduction report indicates that this is far less progress being made than previously thought and there is much more need to be done to improve knowledge of HIV among adolescents and young adults.

1.2 Problem Statement

In Cameroon, the Ministry of Health works hand with the country government for quality HIV treatment Management. This ensures that communities are healthy: which is important for the growth of the economy. ART suppresses HIV viral load of the person infected.  patients living with HIV(PLWHIV) who are on proper ART are less likely to spread the virus as they have low HIV viral load in their body systems.

A large pool of researchers has identified social, cultural and economic barriers to antenatal and postnatal adherence to ART over time. Low adherence levels are problematic because poor adherence to ART leads to increased risk of mother to child transmission of HIV, virologic failure and a high risk of drug resistance that may eventually need a change to more expensive ARV drug combination. (Ngarina, 2013).

Cameroon has one of the highest rate of HIV in West and Central Africa ,with 5.3% of the adult population living with HIV of these , only 30% are receiving ART. Adherence to ART in Cameroon has changed over the years for a multitude if reasons . Health systems changes like the decentralized HIV centers and the subsidy of cost of medication and testing over the year have contributed to the variation in the reported adherence rate (Mbuagbaw et al ,2012). Adolescent make up about 21% of the population in Cameroon. An estimated number of adolescent living with HIV in Cameroon is 3900(2%) of the total number in Sub-Sharan Africa (UNICEF,2008).This makes adherence to ART in adolescent a global issue of which Cameroon cannot be left out.

However, poor competency that is; poor team work, poor communication, untrustworthiness and poor ethics of some nurses and misguided practice that is; answering a phone, asking personal questions, speaking too much.

These makes client(adolescent) to feel insecure, rejected and psychologically down because of poor communication skills, non-receptive facial expression of the nurses, without forgetting their lack of proper interaction with their client, the adolescent will not receive adequate counseling especially on initiation which sets the base for treatment success. This will lead to more complication like the development of opportunistic infection (OI) non-suppression viral load and treatment failure.

1.3 Research Question

1. What is the prevalence of non – adherence to ART among adolescence living with HIV?
2. What knowledge does HIV positive adolescence have on the importance of adherence to ART?
3. What are the factors influencing the adherence to ART among adolescence patients living with HIV?

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