HIV-positive adolescents on antiretroviral therapy (ART) often have lower viral suppression rates when compared to both adults and younger children: meaning their viral load remains relatively high, even though they are taking ART. This treatment failure is most likely due to lower adherence to ART, although other factors such as having been on ART for a long time (since infancy in some cases), initial sub-optimal drug regimens, drug interactions or malabsorption are also possible causes. Maintaining adherence to ART is one of the most significant challenges for optimizing health outcomes in adolescents living with HIV. It has immediate health and HIV prevention benefits, as well as delaying the development of drug resistance. With the limited availability of multiple ART combinations, adherence is also instrumental in preserving future drug options. This is critically important for adolescents who may already be heavily treatment experienced and may feel discouraged by side-effects and/or treatment fatigue.
While the importance of adherence is understood, it can be more challenging among adolescents due to their emotional and lifestyle characteristics, as well as cultural and social factors and health service issues. In addition, adolescents often lack the information they need to understand HIV and effective treatment. Most significantly, because of their young age, adolescents on ART must accept the reality of lifelong treatment, which can be a daunting prospect. Health providers and community-based services play a vital role in supporting adherence during adolescence, helping adolescents on ART to reach adulthood safely with good adherence practices.
Health providers can support adherence among adolescents by recognizing that they are still evolving physically, psychologically and socially, and that their emerging independence needs to be supported and facilitated. At the same time, careful assessment of an adolescent’s adherence practices and identification of the individual influences on non-adherence can help health providers develop an appropriate strategy to address specific adherence issues.
WHO recommendation on Adherence
Community-based approaches can improve treatment adherence and retention in care of adolescents living with HIV. Read more