Predictors of Non-Adherence to Antiretroviral Therapy among Adolescents Living with HIV in the Centre Region of Cameroon

Introduction: In spite of progress in antiretroviral therapy (ART) programs, adolescents remain largely vulnerable to poor ART outcomes, due to non-adherence. In the frame of limited evidence on ART adherence during adolescence in resource-constrained settings, we aimed at evaluating the rate of adherence to ART among adolescents and associated factors in Cameroon. Methods: A cross-sectional study was conducted among 401 adolescents receiving ART in 13 health facilities of the Centre Region of Cameroon, from April through August 2018. Adherence was evaluated using a composite of both self-reported and pill count assessments. Risk factors of non-adherence were assessed using the socio-ecological model and p<0.05 were considered statistically significant. Results: Mean age was 14.63 (±2.89) and 55.9 % (224) were female. Rate of adherence was 25.2% (composite-assessment), 38.2% (pill-count) and 60.6% (self-reported). Following the composite-assessment, non-adherence was significantly higher in: vertically vs. horizontally infected adolescents (OR 4.24; 95% CI: 2.16-8.33, p<0.001); facilities with combined adult/adolescent vs. specialized adolescent care (0.32; 95% CI: 0.20-0.52, p<0.001); living beyond 5 km from the heath facility (OR 1.99; 95% CI: 1.26-3.15, p=0.003; inconvenient clinic appointments (OR 3.03; 95% CI: 1.78-5.16, p<0.001); Following multivariate analysis, non-adherence was associated with “living beyond 5 km from the heath facility” (OR 1.84, 95% CI: 1.01-3.33, p=0.045); “adolescents taking medication in the same service with adult” (OR 0.11, 95% CI: 0.03-0.35, p<0.001), managed at a rural health facility (OR 4.29, 95% CI: 1.84-9.96, p=0.001) and not counseled regularly (OR 0.02, 95% CI: 0.01-0.36, p=0.007). Conclusion: In the Centre region of Cameroon, about three-quarters of adolescents might be non-adherent to ART. Interventions towards improved adherence should focus on adolescents managed at the rural health facility and with vertical HIV-infection. Furthermore, convenient clinic appointments, creation of friendly adolescent healthcare centres and decentralising HIV-adolescent care in rural settings would improve adherence to ART program