Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators
Abstract
:1. Introduction
2. Methods
2.1. Study Site and Recruitment
2.2. Data Collection
2.3. Determination of ART Adherence
2.4. Data Analysis
2.5. Sensitivity Analysis
3. Results
3.1. Participant Demographics
3.2. Sexual History and Rates of Violence
3.3. Mental Health Measures
3.4. Adherence Measures
3.5. ART Adherence Models: CDC Viral Load Cut-Off plus CASE Index Model
3.6. Sensitivity Analysis for Adherence Measures (Table A1)
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Viral Load > 200 copies/mL: Poor ART Adherence n = 4 | Viral Load < 200 copies/mL: Good ART Adherence n = 44 | Viral Load Missing: Missing ART Adherence n = 261 | |
---|---|---|---|
CASE Adherence Results | |||
Poor ART Adherence | 0 (0%) | 3 (6.82%) | 64 (23.46%) |
Good ART Adherence | 4 (100%) | 41 (93.18%) | 199 (76.54%) |
Missing CASE Index | 0 | 0 | 1 |
Original Model a | Sensitivity Analysis b | |
---|---|---|
Adjusted OR (95% CI) | Adjusted OR (95% CI) | |
No Sexual Violence † | (Ref) | (Ref) |
Any Sexual Violence † | 1.14 (0.62–2.10) | 1.32 (0.72–2.44) |
No Emotional Violence †† | (Ref) | (Ref) |
Any Emotional Violence †† | 1.94 (1.03–3.66) | 2.22 (1.17–4.21) |
No Physical Violence †† | (Ref) | (Ref) |
Any Physical Violence †† | 1.67 (0.88–3.15) | 1.87 (0.999–3.53) |
No Substance Use †† | (Ref) | (Ref) |
Substance Use †† | 2.70 (1.24–5.92) | 2.30 (1.05–5.05) |
PHQ: Minimal †† | (Ref) | (Ref) |
PHQ: Mild †† | 1.44 (0.74–2.79) | 1.43 (0.74–2.77) |
PHQ: Moderate+ †† | 3.19 (1.47–6.94) | 2.36 (1.08–5.20) |
Good Adherence | Poor Adherence | |||||
---|---|---|---|---|---|---|
n | % | n | % | Crude OR (95% CI) | Adjusted OR (95% CI) | |
No Sexual Violence † | 157 | 66.24 | 42 | 60.00 | (Ref) | (Ref) |
Any Sexual Violence † | 80 | 33.76 | 28 | 40.00 | 1.31 | 1.16 (0.63–2.14) |
No Emotional Violence †† | 151 | 63.45 | 37 | 52.86 | (Ref) | (Ref) |
Any Emotional Violence †† | 87 | 36.55 | 33 | 47.14 | 1.50 (0.90–2.65) | 1.86 (0.99–3.49) |
No Physical Violence †† | 178 | 75.74 | 45 | 65.22 | (Ref) | (Ref) |
Any Physical Violence †† | 57 | 24.26 | 24 | 34.78 | 1.67 (0.93–2.97) | 1.60 (0.84–3.02) |
No Substance Use †† | 211 | 89.41 | 51 | 72.86 | (Ref) | (Ref) |
Substance Use †† | 25 | 10.59 | 19 | 27.14 | 3.14 (1.61–6.15) | 2.40 (1.09–5.29) |
PHQ: Minimal †† | 127 | 56.19 | 27 | 40.91 | (Ref) | (Ref) |
PHQ: Mild †† | 76 | 33.63 | 20 | 30.30 | 1.24 (0.65–2.36) | 1.35 (0.69–2.63) |
PHQ: Moderate+ †† | 23 | 10.18 | 19 | 28.79 | 3.89 (1.86–8.11) | 3.23 (1.24–6.00) |
Appendix A.1. Table A3 Model: WHO Viral Load Cut-Off plus CASE Index
References
- Risher, K.A.; Cori, A.; Reniers, G.; Marston, M.; Calvert, C.; Crampin, A.; Dadirai, T.; Dube, A.; Gregson, S.; Herbst, K.; et al. Age patterns of HIV incidence in eastern and southern Africa: A modelling analysis of observational population-based cohort studies. Lancet HIV 2021, 8, e429–e439. [Google Scholar] [CrossRef] [PubMed]
- Kenya Ministry of Health. The Kenya AIDS Strategic Framework (KASF II) (2020/2021–2024/2025). 2020. Available online: https://nsdcc.go.ke/wp-content/uploads/2021/05/KASFII_Web-10-Final.pdf (accessed on 31 July 2023).
- The Need for Wider Implementation of People-Centred Differentiated Service Delivery for HIV Testing and Treatment in Africa. Available online: https://www.unaids.org/en/resources/presscentre/featurestories/2021/december/20211210_differentiated-service-delivery (accessed on 31 July 2023).
- Hudelson, C.; Cluver, L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: A systematic review. AIDS Care 2015, 27, 805–816. [Google Scholar] [CrossRef] [PubMed]
- Ridgeway, K.; Dulli, L.; Murray, K.; Silverstein, H.; Dal Santo, L.; Olsen, P.; Darrow de Mora, D.; McCarraher, D. Interventions to improve antiretroviral therapy adherence among adolescents in low- and middle-income countries: A systematic review of the literature. PLoS ONE 2018, 13, e0189770. [Google Scholar] [CrossRef] [PubMed]
- Ortego, C.; Huedo-Medina, T.B.; Santos, P.; Rodríguez, E.; Sevilla, L.; Warren, M.; Llorca, J. Sex differences in adherence to highly active antiretroviral therapy: A meta-analysis. AIDS Care 2012, 24, 1519–1534. [Google Scholar] [CrossRef]
- Pellowski, J.A.; Price, D.M.; Harrison, A.D.; Tuthill, E.L.; Myer, L.; Operario, D.; Lurie, M.N. A Systematic Review and Meta-analysis of Antiretroviral Therapy (ART) Adherence Interventions for Women Living with HIV. AIDS Behav. 2019, 23, 1998–2013. [Google Scholar] [CrossRef] [PubMed]
- Kola, L.; Kohrt, B.A.; Hanlon, C.; Naslund, J.A.; Sikander, S.; Balaji, M.; Benjet, C.; Cheung, E.Y.L.; Eaton, J.; Gonsalves, P.; et al. COVID-19 mental health impact and responses in low-income and middle-income countries: Reimagining global mental health. Lancet Psychiatry 2021, 8, 535–550. [Google Scholar] [CrossRef]
- Mazza, M.; Marano, G.; Lai, C.; Janiri, L.; Sani, G. Danger in danger: Interpersonal violence during COVID-19 quarantine. Psychiatry Res. 2020, 289, 113046. [Google Scholar] [CrossRef]
- Sarvey, D.; Welsh, J.W. Adolescent substance use: Challenges and opportunities related to COVID-19. J. Subst. Abus. Treat. 2021, 122, 108212. [Google Scholar] [CrossRef]
- MEASURE DHS/ICF International. Demographic and Health Survey’s DHS Toolkit of Methodology for the MEASURE DHS Phase III Project; MEASURE DHS/ICF International: Washington, DC, USA, 2008. [Google Scholar]
- Tele, A.K.; Carvajal-Velez, L.; Nyongesa, V.; Ahs, J.W.; Mwaniga, S.; Kathono, J.; Yator, O.; Njuguna, S.; Kanyanya, I.; Amin, N.; et al. Validation of the English and Swahili Adaptation of the Patient Health Questionnaire–9 for Use Among Adolescents in Kenya. J. Adolesc. Health 2023, 72 (Suppl. S1), S61–S70. [Google Scholar] [CrossRef]
- Nyongesa, M.K.; Mwangi, P.; Koot, H.M.; Cuijpers, P.; Newton, C.R.J.C.; Abubakar, A. The reliability, validity and factorial structure of the Swahili version of the 7-item generalized anxiety disorder scale (GAD-7) among adults living with HIV from Kilifi, Kenya. Ann. Gen. Psychiatry 2020, 19, 62. [Google Scholar] [CrossRef]
- Jefferies, P.; McGarrigle, L.; Ungar, M. The CYRM-R: A Rasch-Validated Revision of the Child and Youth Resilience Measure. J. Evid.-Based Soc. Work. 2019, 16, 70–92. [Google Scholar] [CrossRef]
- Vreeman, R.C.; Scanlon, M.L.; Tu, W.; Slaven, J.E.; McAteer, C.I.; Kerr, S.J.; Bunupuradah, T.; Chanthaburanum, S.; Technau, K.-G.; Nyandiko, W.M. Validation of a self-report adherence measurement tool among a multinational cohort of children living with HIV in Kenya, South Africa and Thailand. J. Int. AIDS Soc. 2019, 22, e25304. [Google Scholar] [CrossRef] [PubMed]
- Naomi, W.; Peter, G.; Mbuthia, J.; Joshua, M.; Ndwiga, T. Determinants of Adherence to Antiretroviral Among HIV Positive Adolescents at Comprehensive Care Clinic, Gertrude’s Children Hospital, Nairobi, Kenya. Am. J. Nurs. Sci. 2018, 7, 23. [Google Scholar] [CrossRef]
- Byabene, A.K.; Fortes-Déguénonvo, L.; Niang, K.; Manga, M.N.; Bulabula, A.N.H.; Nachega, J.B.; Seydi, M. Optimal antiretroviral therapy adherence as evaluated by CASE index score tool is associated with virological suppression in HIV-infected adults in Dakar, Senegal. Trop. Med. Int. Health 2017, 22, 776–782. [Google Scholar] [CrossRef] [PubMed]
- Hodes, R.; Cluver, L.; Toska, E.; Vale, B. Pesky metrics: The challenges of measuring ART adherence among HIV-positive adolescents in South Africa. Crit. Public Health 2020, 30, 179–190. [Google Scholar] [CrossRef]
- Dow, D.E.; Turner, E.L.; Shayo, A.M.; Mmbaga, B.; Cunningham, C.K.; O’Donnell, K. Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania. AIDS Care 2016, 28, 825–833. [Google Scholar] [CrossRef] [PubMed]
- Gaitho, D.; Kumar, M.; Wamalwa, D.; Wambua, G.N.; Nduati, R. Understanding mental health difficulties and associated psychosocial outcomes in adolescents in the HIV clinic at Kenyatta National Hospital, Kenya. Ann. Gen. Psychiatry 2018, 17, 29. [Google Scholar] [CrossRef]
- Mutumba, M.; Musiime, V.; Lepkwoski, J.M.; Harper, G.W.; Snow, R.C.; Resnicow, K.; Bauermeister, J.A. Examining the relationship between psychological distress and adherence to anti-retroviral therapy among Ugandan adolescents living with HIV. AIDS Care 2016, 28, 807–815. [Google Scholar] [CrossRef]
- Nakimuli-Mpungu, E.; Bass, J.; Alexandre, P.; Mills, E.; Musisi, S.; Ram, M.; Katabira, E.; Nachega, J. Depression, alcohol use and adherence to antiretroviral therapy in sub-Saharan Africa: A systematic review. AIDS Behav. 2012, 16, 2101–2118. [Google Scholar] [CrossRef]
- Vreeman, R.C.; McCoy, B.M.; Lee, S. Mental health challenges among adolescents living with HIV. J. Int. AIDS Soc. 2017, 20, 21497. [Google Scholar] [CrossRef]
- Bhana, A.; Kreniske, P.; Pather, A.; Abas, M.A.; Mellins, C.A. Interventions to address the mental health of adolescents and young adults living with or affected by HIV: State of the evidence. J. Int. AIDS Soc. 2021, 24, e25713. [Google Scholar] [CrossRef]
- Laurenzi, C.A.; Skeen, S.; Gordon, S.; Akin-Olugbade, O.; Abrahams, N.; Bradshaw, M.; Brand, A.; du Toit, S.; Melendez-Torres, G.J.; Tomlinson, M.; et al. Preventing mental health conditions in adolescents living with HIV: An urgent need for evidence. J. Int. AIDS Soc. 2020, 23, e25556. [Google Scholar] [CrossRef] [PubMed]
- Kim, M.H.; Mazenga, A.C.; Yu, X.; Ahmed, S.; Paul, M.E.; Kazembe, P.N.; Abrams, E.J. High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: Barriers and associated factors. J. Int. AIDS Soc. 2017, 20, 21437. [Google Scholar] [CrossRef] [PubMed]
- Merrill, K.G.; Campbell, J.C.; Decker, M.R.; McGready, J.; Burke, V.M.; Mwansa, J.K.; Miti, S.; Frimpong, C.; Kennedy, C.E.; Denison, J.A. Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults. AIDS Behav. 2021, 25, 1373–1383. [Google Scholar] [CrossRef]
- Cluver, L.D.; Zhou, S.; Orkin, M.; Rudgard, W.; Meinck, F.; Langwenya, N.; Vicari, M.; Edun, O.; Sherr, L.; Toska, E. Impacts of Intimate Partner Violence and Sexual Abuse on Antiretroviral Adherence among Adolescents Living with HIV in South Africa. AIDS 2023, 37, 503. Available online: https://journals.lww.com/aidsonline/Fulltext/2023/03010/Impacts_of_intimate_partner_violence_and_sexual.13.aspx (accessed on 31 July 2023). [CrossRef]
- Gibbs, A.; Reddy, T.; Closson, K.; Cawood, C.; Khanyile, D.; Hatcher, A. Intimate Partner Violence and the HIV Care and Treatment Cascade among Adolescent Girls and Young Women in DREAMS, South Africa. J. Acquir. Immune Defic. Syndr. 2022, 89, 136. Available online: https://journals.lww.com/jaids/Fulltext/2022/02010/Intimate_Partner_Violence_and_the_HIV_Care_and.3.aspx (accessed on 31 July 2023). [CrossRef]
- Biomndo, B.C.; Bergmann, A.; Lahmann, N.; Atwoli, L. Intimate partner violence is a barrier to antiretroviral therapy adherence among HIV-positive women: Evidence from government facilities in Kenya. PLoS ONE 2021, 16, e0249813. [Google Scholar] [CrossRef]
- KNBS; ICF. Kenya Demographic and Health Survey 2022: Volume 1. Published online 15 June 2023. Available online: https://dhsprogram.com/publications/publication-fr380-dhs-final-reports.cfm (accessed on 4 October 2023).
- Closson, K.; Ndungu, J.; Beksinska, M.; Ogilvie, G.; Dietrich, J.J.; Gadermann, A.; Gibbs, A.; Nduna, M.; Smit, J.; Gray, G.; et al. Gender, Power, and Health: Measuring and Assessing Sexual Relationship Power Equity Among Young Sub-Saharan African Women and Men, a Systematic Review. Trauma Violence Abus. 2022, 23, 920–937. [Google Scholar] [CrossRef] [PubMed]
- Jewkes, R.K.; Dunkle, K.; Nduna, M.; Shai, N. Intimate partner violence, relationship power inequity, and incidence of HIV infection in young women in South Africa: A cohort study. Lancet 2010, 376, 41–48. [Google Scholar] [CrossRef]
- Ng’eno, B.N.; Kellogg, T.A.; Kim, A.A.; Mwangi, A.; Mwangi, M.; Wamicwe, J.; Rutherford, G.W. Modes of HIV transmission among adolescents and young adults aged 10–24 years in Kenya. Int. J. STD AIDS 2018, 29, 800–805. [Google Scholar] [CrossRef]
CASE Adherence Index Results | ||
---|---|---|
Viral Load Results | Poor Adherence | Good Adherence |
Poor Adherence (≥200 copies of HIV/mL) | Poor ART Adherence | Poor ART Adherence |
Good Adherence (<200 copies of HIV/mL) | Poor ART Adherence | Good ART Adherence |
Variables | No. (%) n = 309 |
---|---|
Clinic Type | |
Urban | 124 (40.13) |
Rural | 185 (59.87) |
Age Group | |
Under 18 | 60 (19.42) |
18–22 | 122 (39.48) |
23+ | 127 (41.1) |
Age in years (Median, IQR) | 21.0 (18.0–23.0) |
Household Size (Median, IQR) | 6.0 (4.0–7.0) |
Maternal Education | |
No Education | 2 (0.65) |
Primary School, Incomplete | 37 (11.97) |
Primary School, Complete | 93 (30.1) |
Secondary School, Incomplete | 20 (6.47) |
Secondary School, Complete | 50 (16.18) |
Post-secondary School, Complete | 22 (7.12) |
Unknown a | 85 (27.51) |
Living Parents | |
Both Parents Alive | 106 (34.3) |
Only Mother Alive | 99 (32.04) |
Only Father Alive | 29 (9.39) |
Neither Parent Alive | 75 (24.27) |
Self-reported Food Insecurity | |
Yes | 128 (41.42) |
No | 181 (58.58) |
Boyfriend in last 12 months | |
Yes | 232 (76.32) |
No | 72 (23.68) |
Missing Current Boyfriend b | 5 |
Self-reported substance use | |
Never | 263 (85.67) |
Ever | 44 (14.33) |
Missing substance use b | 2 |
CASE Adherence Index | |
Poor Adherence | 67 (21.75) |
Good Adherence | 241 (78.25) |
Missing Adherence a | 1 |
Viral Load Data c | |
<200 copies/mL | 44 (91.7%) |
≥200 copies/mL | 4 (8.3%) |
≥1000 copies/mL | 3 (6.3%) |
Missing viral load data w/in last six months a | 261 |
Variables | No. (%) n = 309 |
---|---|
Ever had sex | |
Yes | 216 (70.59) |
No | 90 (29.41) |
Missing ever had sex a | 3 |
Ever had transactional sex b | |
Yes | 60 (27.78) |
No | 156 (72.22) |
Physical Intimate Partner Violence | |
Reported | 82 (26.89) |
Missing a | 4 |
Emotional Intimate Partner Violence | |
Reported | 120 (38.83) |
Any Sexual Violence | |
Reported | 108 (34.95) |
Missing a | 1 |
Non-partner Sexual Violence | |
Reported | 84 (27.27) |
Missing a | 1 |
Partner Sexual Violence | |
Reported | 56 (18.18) |
Missing a | 1 |
Sexual Assault | |
Any completed sexual assault | 91 (29.55) |
Partner sexual assault | 44 (14.29) |
Non-partner sexual assault | 63 (20.45) |
Missing completed sexual assault a | 1 |
Reported Perpetrators of Non-partner Sexual Assault | |
Authority Figure | 6 (9.52) |
Family Member or Relative | 12 (19.05) |
Friend | 10 (15.87) |
Neighbor | 14 (22.22) |
Other | 7 (11.11) |
Don’t Know | 12 (19.05) |
Refused | 2 (0.65) |
Variables | No. (%) n = 309 |
---|---|
Mental Health Measure | |
PHQ-9 Depression Score | |
No/Minimal Depression (0–4) | 154 (52.56) |
Mild Depression (5–9) | 97 (33.11) |
Moderate Depression (10–14) | 30 (10.24) |
Moderately Severe Depression (15–19) | 9 (3.07) |
Severe Depression (20–27) | 3 (1.02) |
Missing a | 16 |
GAD Anxiety Score | |
No/Minimal Anxiety (0–4) | 184 (64.11) |
Mild Anxiety (5–9) | 86 (29.97) |
Moderate Anxiety (10–14) | 10 (3.48) |
Severe Anxiety (15–21) | 7 (2.44) |
Missing a | 22 |
CYRM-R Score (Median, IQR) | 47 (43–49) |
Good Adherence | Poor Adherence | |||||
---|---|---|---|---|---|---|
n | % | N | % | Crude OR (95% CI) | Adjusted OR (95% CI) | |
No Sexual Violence † | 156 | 66.10 | 43 | 60.56 | (Ref) | (Ref) |
Any Sexual Violence † | 80 | 33.90 | 28 | 39.44 | 1.27 (0.73–2.19) | 1.14 (0.62–2.10) |
No Emotional Violence †† | 151 | 63.71 | 37 | 52.11 | (Ref) | (Ref) |
Any Emotional Violence †† | 86 | 36.29 | 34 | 47.89 | 1.61 (0.94–2.76) | 1.94 (1.03–3.66) |
No Physical Violence †† | 178 | 76.07 | 45 | 64.29 | (Ref) | (Ref) |
Any Physical Violence †† | 56 | 23.93 | 25 | 35.71 | 1.77 (0.99–3.13) | 1.67 (0.88–3.15) |
No Substance Use †† | 211 | 89.79 | 51 | 71.83 | (Ref) | (Ref) |
Substance Use †† | 24 | 10.21 | 20 | 28.17 | 3.45 (1.77–6.72) | 2.71 (1.24–5.92) |
PHQ: Minimal †† | 127 | 56.44 | 27 | 40.30 | (Ref) | (Ref) |
PHQ: Mild †† | 75 | 33.33 | 21 | 31.34 | 1.32 (0.70–2.49) | 1.44 (0.74–2.79) |
PHQ: Moderate+ †† | 23 | 10.22 | 19 | 28.36 | 3.89 (1.86–8.11) | 3.19 (1.47–6.94) |
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Altamirano, J.; Odero, I.A.; Omollo, M.; Awuonda, E.; Ondeng’e, K.; Kang, J.L.; Behl, R.; Ndivo, R.; Baiocchi, M.; Barsosio, H.C.; et al. Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators. Int. J. Environ. Res. Public Health 2023, 20, 6922. https://doi.org/10.3390/ijerph20206922
Altamirano J, Odero IA, Omollo M, Awuonda E, Ondeng’e K, Kang JL, Behl R, Ndivo R, Baiocchi M, Barsosio HC, et al. Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators. International Journal of Environmental Research and Public Health. 2023; 20(20):6922. https://doi.org/10.3390/ijerph20206922
Chicago/Turabian StyleAltamirano, Jonathan, Isdorah A. Odero, Mevis Omollo, Eucabeth Awuonda, Ken Ondeng’e, Jennifer L. Kang, Rasika Behl, Richard Ndivo, Michael Baiocchi, Hellen C. Barsosio, and et al. 2023. "Understanding ART Adherence among Adolescent Girls and Young Women in Western Kenya: A Cross-Sectional Study of Barriers and Facilitators" International Journal of Environmental Research and Public Health 20, no. 20: 6922. https://doi.org/10.3390/ijerph20206922