The Role and Perspectives of Caregivers in Childhood Antiretroviral Therapy (ART) Adherence: Results of a Cross-Sectional Study in Urban Cameroon

Background: In sub-Saharan Africa, including Cameroon, children living with HIV depend almost entirely on their primary caregivers for daily antiretroviral therapy (ART). Although ART has made HIV a manageable condition, adherence among young children remains low because of caregiver-related, child-related, social, and structural challenges. Objective: This study explored the roles, challenges, and perspectives of primary caregivers of children aged 0 - 9 years living with HIV in two urban hospitals in Bamenda, North-West Region, Cameroon. Methods: A descriptive cross-sectional study was conducted from July 2023 to December 2024. Sixty-four primary caregivers were conveniently sampled from Bamenda Regional Hospital (n = 40) and Nkwen Baptist Hospital (n = 20), and 60 completed a semi-structured questionnaire (response rate 94%). Data on their role and perspectives were collected through in-depth interviews (IDI) and analyzed using SPSS version 25 for the quantitative aspect and Thematic Analysis Process for the qualitative aspect to identify themes. The principles of the thematic analysis technique, such as coding of data, searching for themes, refining the themes, and reporting the findings, are relatable to other qualitative methods, such as discourse analysis. Thematic analysis is a method to analyze qualitative data. It involves the identification and reporting of patterns in a data set, which are then interpreted for their inherent meaning; these patterns can be found on the basis of understanding the meaning of keywords used by caregivers. Results: Most (55%) of caregivers were female, 78% of respondents were biologically related to the child, and the child stayed with the child’s parents, while 93% of caregivers used reminder systems that help them administer the child’s medications and other care. Self-reported adherence was good, as ≥85% of caregivers reported it, and compliance with doses was reported by 83% of caregivers of children. Primary caregivers played multiple roles, including administering medicines—notably by mothers, as reported in 38% of cases—providing nutritional and emotional support by 32% of respondents, and 68% of caregivers ensured linking children to clinic services. The main challenges faced by respondents were forgetfulness, reported by 57% of primary caregivers; lack of food, as 72% reported that drugs are not administered at times when food was insufficient; 23% had skipped doses because no food was available; 77% reported transport difficulties; 44%