Determinants of anti-retroviral therapy adherence among adolescents living with HIV in the Kingdom of Eswatini

BackgroundThe success of antiretroviral therapy (ART) depends on a high level of adherence to the life-long therapy of 95% and above. However, in Eswatini, adolescents and young people aged 15 to 24 years, have poor ART adherence as evidenced by low viral load (VL) suppression rates (76% and 63% among female and males respectively) compared to the general population (96%). The wide age-band of 15 to 24 years in reporting viral suppression rates means that adolescent specific data is limited, and younger adolescents aged 10-14 years are excluded. This study explored the level of ART adherence and associated factors among adolescents living with HIV (ALHIV) aged 10 to 19 years on ART in Eswatini. MethodsWe performed a retrospective analysis of 911 medical records of ALHIV aged 10 to 19 years on ART for at least a month in Eswatini for the period 1st January 2017 to 30th September 2022. Bivariate logistic regression was fitted for each predictor variable. Missing values were imputed using multiple imputation by chained equation (MICE). Statistically significant (p-value [≤]0.2) predictor variables were included in a multivariable logistic regression model. P-value [≤]0.05 was used to declare statistical significance in the final regression model. ResultsART adherence of 88.5% was recorded with higher adherence among males (88.9%) than females (87.8%). Hhohho region had highest adherence (90.7%) while Shiselweni region had lowest adherence (82%). Adherence was low among ALHIV with a non-suppressed baseline VL result (65.3%) and those assigned to multi-month ART model of care at ART initiation (66.7%). The Shiselweni region (OR 0.47; 95%CI 0.26-2.78), suppressed baseline VL result (OR 5.49; 95%CI 3.36-8,96) and assigned to the main-stream ART care model (OR 0.22; 95%CI 0.05-0.95) were statistically associated with ART adherence. In the multivariable regression analysis, only Shiselweni region and suppressed baseline VL result were statistically associated with ART adherence. ConclusionEswatini ALHIV have a low ART adherence compared to general population. Shiselweni region is negatively associated with ART adherence among ALHIV while a suppressed baseline VL is positively associated with improved ART adherence. There is therefore a need to intensify interventions aimed at early ART initiation and intensive follow-up and support among ALHIV especially in the Shiselweni region.