Determinants of Adherence to Antiretroviral Among HIV Positive Adolescents at Comprehensive Care Clinic, Gertrude’s Children Hospital, Nairobi, Kenya
American Journal of Nursing Science
Volume 7, Issue 1, February 2018, Pages: 23-30
Received: Oct. 17, 2017; Accepted: Nov. 2, 2017; Published: Jan. 17, 2018
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Wambugu Naomi, Nursing Department, Gertrude’s Children Hospital, Nairobi, Kenya
Gatongi Peter, Department of Epidemiology & Biostatistics, Moi University, Eldoret, Kenya
Joe Mbuthia, Department of Paediatrics, Gertrude’s Children Hospital, Nairobi, Kenya
Mokaya Joshua, Fish for Nutrition Project, German Technical Co-operation (GTZ), Nairobi, Kenya
Taratisio Ndwiga, Department of Environmental Health, Moi University, Eldoret, Kenya
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Antiretroviral drugs (ARVs) requires adherence of more than 95% for adequate viral suppression. The consequences of poor adherence are failure of viral suppression, decrease CD4 cell count, disease progression, drug resistance, risk of transmission of resistance virus and limited future treatment options. Published data on adherence to ARVs in Kenyan adolescents is limited. The purpose of this study was to determine the ARVS adherence level and describe the healthcare system, medication and social environmental factors affecting this adherence among Human Immune-deficiency Virus (HIV) positive adolescents. This was a descriptive cross-sectional study, where 185 patients aged 10-18 years who had been on ARVs for at least two years were systematically and randomly selected. Only 129 respondents who were HIV fully disclosed were interviewed using a structured questionnaire about their experience taking ARVs. Adherence was measured based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Data was also collected via Focused Group Discussion, Key Informant Interviews and from records retrieval. Data analysis was done using Epi data software 3.1 with statistical significance set at p<0.05. Overall, 185 patients were selected but 129 disclosed patients were interviewed; 52.7% males and 47.3% females, estimated level of adherence of 67.34% and the main (63.6%) reason for missing therapy was forgetting. Long waiting time in the clinic and stigmatization were other factors found to affect adherence. The CASE Index Tool depicted high reliability with a Cronbach’s α=0.696. The results showed a significant positive correlation between CD4 counts and adherence (Rh0=0.255, p=0.003) and a significant inverse correlation between Viral Load levels and Adherence (Rh0= -0.189, p=0.031). Therefore, the 67.34% adherence level to ART reported in this study is below optimum adherence of 95%. This study gives the following recommendations; (a) Policy review on HIV disclosure procedures with training of health workers on it (b) Put fitting strategies to improve patients’ ability to impact on forgetfulness (c) Clinic staff to adopt the use of CASE Tool in assessing adolescent’s adherence to ARVs.
HIV Infected Adolescents, Comprehensive Care Clinic, Adherence to ARVs
To cite this article
Wambugu Naomi, Gatongi Peter, Joe Mbuthia, Mokaya Joshua, Taratisio Ndwiga, Determinants of Adherence to Antiretroviral Among HIV Positive Adolescents at Comprehensive Care Clinic, Gertrude’s Children Hospital, Nairobi, Kenya, American Journal of Nursing Science. Vol. 7, No. 1, 2018, pp. 23-30. doi: 10.11648/j.ajns.20180701.13
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Amberbir, A., Woldemichael, K., Getachew, S., Girma, B., & Deribe, K., (2008). Disclosure experience and associated factors among HIV positive men and women clinical service users in Southwest Ethiopia –A Prospective Study. Biomed Central J. of Public Health.
Arrive, E., Dicko, F., Amghar, H., Aka, A. E, Dior, H., Bouah, B., Traoré, M., Ogbo, P., Dago-Akribi, H. A., Eboua, T. K. F., Kouakou, K., Sy, H. S., Alioum, A., Dabis, F., Ekouevi, D. K., Lero, V.; For the Pediatric leDEA West Africa Working Group (2012). HIV Status Disclosure and Retention in Care in HIV-Infected Adolescents on Antiretroviral Therapy (ART) in West Africa. From
Ayres, J. R. C., Paiva, V., Franca, I., Gravato, N., Lacerda, R., Negra, M., Marques, H. H. S., Galano, E., Lecussan, P., Segurado, A. C & Silva, M. H., (2006). Vulnerability, Human Rights, and Comprehensive Health Care Needs of Young People Living with HIV/AIDS. American Journal of Public Health 96 (6): 1001-1006.
Bakanda, C., Birungi, J., Mwesigwa, R., Nachega, J. B, Chan, K., Palmer, A., Ford, N., Mills, E. J., (2011). Survival of HIV-Infected Adolescents on Antiretroviral Therapy In Uganda: Findings From A Nationally Representative Cohort In Uganda.
Biadgilign, S., Deribew, A., Amberbir, A. & Deribe, K., (2008). Adherence to Highly Active Antiretroviral Therapy and Its Correlates among HIV Infected Pediatric Patients in Ethiopia. Biomedica Central Pediatrics, 8: 53-60.
Charles M, Noel F, Leger P, Severe P, Riviere C, Beauharnais CA, et al. (2008). Survival, plasma HIV-1 RNA concentrations and drug resistance in HIV-1-infected Haitian adolescents and young adults on antiretrovirals. Bull World Health Organ (86): 970–7.
Chesney, M., Morin, M., and Sherr, L., (2000). Adherence to HIV combination therapy; Soc. Sci Med. 50: 1599-1605.
Comulada, W. S, Swendeman, D. T, Rotheram-Borus, M. J, Mattes, K. M & Weiss, R. E. (2003). Use of HAART among Young People Living with HIV. American Journal of Health Behaviour, 27 (4): 389-400.
Do N. T., Phiri, K., Bussmann, H., Gaolathe, T., Marlink, R. G. & Wester, C. W., (2010). Psychosocial Factors Affecting Medication Adherence among HIV-1 Infected Adults Receiving Combination Antiretroviral Therapy (Cart) in Botswana. AIDS Research and Human Retroviruses, 26 (6): 685-691.
Dodds, S., Blakley, T., Lizzotte, J. M., Friedman, L. B., Shaw, K., Martinez, J., Siciliano, C., Walker, L. E., Sotheran, J. L., Sell, R. L., Botwinick, G., Johnson R. L., & Bell D., (2003). Retention, Adherence, and Compliance. Special Needs of HIV-Infected Adolescent Girls and Young Women. Journal of Adolescent Health, 33 (2 Suppl): 39-45.
Eholie, S. P., Tanon, A., Polneau, S., Ouiminga, M., Djadji, A., Kangah-Koffi, C., Diakite, N., Anglaret, X., Kakou, A., Bissagnene, E., (2007). Field Adherence to Highly Active Antiretroviral Therapy in HIV-Infected Adults in Abidjan, Cote d’Ivoire. Journal of Acquired Immune Deficiency Syndrome, 45 (3): 355-358.
Ellis, A. E., Gogel, R. P., Roman, B. R., Watson, J. B., Indyk, D., Rosenberg, G., (2006). A Cross-Sectional Study of Adherence to Short-Term Drug Regiments in Urban Kenya. Social Work Health Care, 42 (3-4): 237-50.
Ferrand, R., Corbett, E., Wood, R., Hargrove, J., Ndhlovu, C., Cowan, F., Gouws, E., Williams, B., (2009). AIDS among older children and adolescents in Southern Africa: projecting the time course and magnitude of the epidemic.
Garvie, P. A., Wilkins, M. L., Young, J. C., (2010). Medication Adherence in Adolescents with Behaviorally-Acquired HIV. Evidence for Using a Multimethod Assessment Protocol. Journal of Adolescent Health; 47 (5): 504-511. Retrieved on January 23rd from
Haberer, J. E., Cook, A., Walker, A. S, Ngambi, M., Ferrier, A., Mulenga, V., Kityo, C., Thomason, M., Kabamba, D., Chintu, C., Gibb, D. M., & Bangsberg, D. R., (2011). Excellent Adherence to Antiretroviral in HIV+ Zambian Children is compromised by Disrupted Routine, HIV Nondisclosure, and Paradoxical Income Effects. Retrieved from
Hardon, A. P., Akurut, D., Comoro, C., Ekezie, C., Irunde, H. F., Gerrits, Kglatwane, J., Kinsman, J., Kwasa, R., Maridadi, J., Moroka, T. M., Moyo, S., Nakiyemba, A., Nsimba, S., Ogenyi, R., Oyabba, T., Temu, F. & R Laing R. (2007) Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care (19) 658–665.
Iliyasu, Z., Kabir, M., Abubakar, I. S, Babashani, M., Zubair, Z. A., (2005). Compliance to Antiretroviral Therapy among AIDS Patients in Aminu Kano Teaching Hospital, Kano, Nigeria. Nigeria Journal of Medicine, 14: 290-294.
Irunde, H., Temu, F., Maridadi, J., Nsimba, S. and Comoro, C. (2006). A study on antiretroviral adherence in Tanzania: a pre-intervention perspective, 2006. Geneva: World Health Organization. 169-243.
Mannheimer, S. B., Mukherjee, R., Hirschhorn, L. R., Dougherty, J., Celano, S. A., Ciccarone, D., Graham, K. K., Mantell, E., Mundy, L. M., Eldred, L., Botsko, M., & Finkelstein, R., (2006). The CASE Adherence Index; a Novel Method for Measuring Adherence to Antiretroviral therapy. AIDS Care 18: 853-861.
Marcellin, F., Boyer, S., Protopopescu, C., Dia, A., Ongolo-Zogo, P., Koulla-Shiro, S., Abega, S. C, Abe, C., Moatti, J. P, Spire, B., Carrieri, M. P., (2008). Determinants of Unplanned Antiretroviral Treatment Interruptions among People Living With HIV in Yaoundé, Cameroon. Journal of Tropical Medicine and International Health, 13 (12): 1470-8.
Marima, R., (2011). Prevalence and Factors Associated with Adherance to ART and Cotrimoxazole Preventive Treatment among HIV Infected Adolescents Attending Outpatients HIV clinics, in Kisumu. A research thesis submitted for Masters degree in Pediatrics to The Aga Khan University. Available at
Martinez, J., Bell, D., Camacho, R., Henry-Reid, L. M., Bell, M., Watson, C., & Rodriguez, F., (2009). Adherence to Antiviral Drug Regimens in HIV-Infected Adolescent Patients engaged in Care in a Comprehensive Adolescent and Young Adult Clinic. Journal of the National Medical Association, 92: 55-61.
Merzel C., Vandevanter, N., Irvine, M., (2008). Adherence to Antiretroviral Therapy among Older Children and Adolescents with HIV. A Qualitative Study of Psychosocial Contexts. AIDS Patient Care STDS 22 (12): 977-987. Accessed on 3rd March, 2013 From
Mills, E. J., Nachega, J. B., Bangsberg, D. R., Singh, S., Rachlis, B., Wu, P., Wilson, K., Buchan, I., Gill, C. J. amd Cooper, C. (2006). Adherence to HAART: A Systemic Review of Developed and Developing Nation Patient-Reported Barriers and Facilitators. Public Library of Service medicine. Vol. 3, no. 11, 2039-2064.
Mostashari, F., Riley, E., Selwyn, P. A., Altice, F. L., (1998). Acceptance and Adherence with Antiretroviral Therapy among HIV-Infected Women in a Correctional Facility. Journal of Acquired Immune Deficiency Syndrome and Human Retrovirology 18, 341-348.
Murphy, D. A., Sarr, M., Durako, S. J, Moscicki, A. B., Wilson, C. M., & Muenz, L. R., (2003). Barriers to HAART Adherence among Human Immunodeficiency Virus-Infected Adolescents. Archives of Pediatric Adolescent Medicine 157 (3): 249-255. Available at
Murphy, D. A., Wilson, C. M., Durako, S. J., Muenz, L., & Belzer, M., (2005). Longitudinal Antiretroviral Adherence among Adolescents Infected with Human Immunodeficiency Virus. Archives of Paediatric Adolescents Medicine, 159: 764-770. Retrieved on June 17th, 2013 from
Nabukeera N B, Kalyesubula I, Musoke et al. (2007). Adherence to Antiretroviral Therapy Among Children attending Mulago Hospital in Uganda. Annals of Tropical Paediatrics. (in press).
Nachega JB, Hislop M, Nguyen H, Dowdy DW, Chaisson RE, Regensberg L, Editorial Commentary 145 et al. (2009). Antiretroviral therapy adherence, virologic and immunologic outcomes in adolescents compared with adults in southern Africa. J Acq Immune Defic Syndr (51): 65–71.
Nakiyemba, A., Aurugai, D. A., Kwasa, R., Oyobba, T., (2005). Factors that Facilitate or Constrain Adherence to Antiretroviral Therapy among Adults in Uganda: A- Pre-Intervention Study. WHO 249-301: Geneva.
National Aids and STIs Control Programme (NASCOP), (2009) & 2007 Kenya AIDS Indicator Survey (KAIS) Final Report. Nairobi: National AIDS/STD Control Programme.
Nyambura, A. W., (2009). Factors that Influence Non-Adherence to Antiretroviral Therapy among HIV and AIDS Patients in Central Province, Kenya. Masters of Public Health thesis (Epidemiology and Disease Control), School of Health Sciences of Kenyatta University.
Orrell, C., Bangsberg, D. R, Badri, M., & Wood, R., (2003). Adherence is not A Barrier to Successful Antiretroviral Therapy in South Africa. Journal of AIDS 17: 1369-1375.
Phalade, N., Nthomang, K., Ngwenya, B., & Seboni, N., (2009). Adherence to Highly Active Antiretroviral Therapy (HAART). Challenges Faced by Adolescents Living with HIV (ALWHA) in Botswana. Presented at the AIDS Impact conference in Botswana. Retrieved on May, 2013. From
Rao, D., Kekwaletswe, T. C., Hosek, S., Martinez, J. & Rodriguez, F. (2007). Stigma and social barriers to medication adherence in urban youth living with HIV. AIDS Care 19 (1), 28-33.
Reddington C, Cohen J, Buldillo A, et al. (2000). Adherence to medication regimen among children with Human immunodeficiency virus. Paediatric Infectious Disease: 19: 1148-53.
Reisner, S. L., Mimiaga, M. J, Skeer, M., Perkovich, B., Johson, C. V & Safren, S. A., (2009). A review of HIV Antiretroviral Adherence and Intervention Studies Among HIV-Infected Youth. Adherence and Intervention in Youth, Topics in HIV Medicine, 17 (1): 14-25.
Rudy, B. J, Murphy, D. A., Harris, D. R., Muenz, L., Ellen, J., (2010). Adolescent Trials Network for HIVAI. Prevalence and Interactions of Patient-Related Risks for Non adherence to Antiretroviral Therapy among Perinatally Infected Youth in the United States. AIDS patient Care STDS 24 (2): 97-104. Retrieved from
Sarna A., Pujari S., Sengar A., Garg R., Gupta I. and Van Dam J. (2008). Adherence to antiretroviral therapy and its determinants amongst HIV patients in India. Indian Journal Medical Research, 127, pp 28-36.
Sung-He, K., Sarah, M. G., Sara, F., and Hellen, W. (2014). Adherence to antiretroviral therapy in adolescents living with HIV: Systematic review and meta-analysis. AIDS Journal; 28: 1945-1956; Wolters Kluwer Health | Lippincott Williams & Wilkins.
Talam, N. C., Gatongi, P., Rotich, J., Kimaiyo, S., (2008). Factors Affecting Antiretroviral Drug Adherence among HIV/AIDS Adult patients Attending HIV/AIDS Clinic at Moi Teaching and Referral Hospital, Eldoret, Kenya. East African Journal of Public Health, 5 (2): 74-78.
United Nations Programme on HIV/AIDS (UNAIDS), (2012). Report on the Global AIDS Epidemic. Accessed on February 19, 2013 from
United Nations, (2009). World Population Prospects: The 2008 Revision. Available online at
Wakibi, S. N., Ng’an’ga, Z. W., and Mbugua, G. G., (2011). Factors Associated with Non Adherence to HAART Therapy in Nairobi, Kenya. Thesis for PHD. Retrieved on 2/07/2013 from
Watt, M. H., Maman, S., Golin, C. E., Earp, J. A., Eng, E., Bangdiwala, S. I. & Jacobson, M., (2010). Factors Associated with Self-Reported Adherence to Antiretroviral Therapy in a Tanzanian Setting. AIDS Care 22, 381-389.
Williams, P. L., Storm, D., Montepiedra, G., Nichols, S., Kammerer, B., Sirois, P. A, Farley, J., & Malee, K., (2006). Predictors of Adherence to Antiretroviral Medications in Children and Adolescents with HIV infection. Paediatrics 118: e1745-e1757. Retrieved March 5, 2013 from
World Health Organization (WHO), (2006). Antiretroviral therapy of HIV infection in infants and children in resource-limited settings: towards universal access: Recommendations for a public health approach: Geneva.
World Health Organization (WHO), (2010). Towards Universal Access. Scaling Up Priority HIV/AIDS Interventions in the Health Sector: Progress Report by WHO; Geneva.
World Health Organization (WHO), (2011). Global Summary of the AIDS Epidemic. Accessed 14/12 /12. From
Zuurmond, M., (2008). Adherence to ARVs-challenges and successes. Available at accessed on 01/26/2012.
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