American Journal of Public Health Research
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American Journal of Public Health Research. 2019, 7(4), 126-136
DOI: 10.12691/ajphr-7-4-1
Open AccessArticle

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

Alice Ketchaji1, 2, , Felix Assah3, Joseph Fokam4, Elvis Asangbeng Tanue5, Francisca Monebenimp3 and Marcelin Ngowe Ngowe6

1Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon

2Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon

3Department of Public Health, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon;

4Department of Microbiology, Haematology, Immunology, Parasitology and Infectious Diseases, Faculty of Medicine and Biomedical Sciences, University of Yaoundé 1, Yaoundé, Cameroon;

5Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, Buea, Cameroon;

6Department of Surgery, Faculty of Health Sciences, University of Buea, Buea, Cameroon

Pub. Date: July 24, 2019

Cite this paper:
Alice Ketchaji, Felix Assah, Joseph Fokam, Elvis Asangbeng Tanue, Francisca Monebenimp and Marcelin Ngowe Ngowe. Predictors of Non-Adherence to Antiretroviral Therapy among Adolescents Living with HIV in the Centre Region of Cameroon. American Journal of Public Health Research. 2019; 7(4):126-136. doi: 10.12691/ajphr-7-4-1


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.

adolescents HIV/AIDS ART predictors non-adherence and centre region of yaounde

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[1]  Davies M-A, Pinto J. Targeting 90–90–90 – don't leave children and adolescents behind. Journal of the International AIDS Society. 2015; 18(7Suppl 6):20745.
[2]  UNAIDS. 2016. Fact sheet, world AIDS day. Available at: assessed on 27th September 2018.
[3]  Ammon N, Mason S, Corkery J. Factors impacting antiretroviral therapy adherence among human immunodeficiency virus-positive adolescents in Sub-Saharan Africa: a systematic review. Public health. 2018;157:20.
[4]  UNAIDS. 2017. Global HIV & AIDS statistics fact sheet. Available at: Assessed on 2th November 2018.
[5]  Bell M. Care of the HIV-positive adolescent. Developmental stages and provider sensitivity play a special role: Posit Aware. Indian J Sex Transm Dis AIDS. 2006; 17(4):36-9.
[6]  Viner RM, Ozer EM, Denny S, Marmot M, Resnick M, Fatusi A, et al. Adolescence and the social determinants of health. Lancet. 2012; 379(9826):1641-52.
[7]  Biressaw S, Abegaz, W. E., Abebe, M., Taye, W. A., & Belay,M. Adherence to antiretroviral therapy and associated factors among HIV infected children in Ethiopia:. BMC Pediatrics. 2013.
[8]  UNAIDS. 2016. Global AIDS Update. Geneva, Switzerland: The Joint United Nations Programme on HIV/AIDS. Available at: Assessed on 3th November 2018
[9]  Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care. 2015; 27(7):805-16.
[10]  UNAIDS.2016. ALL IN to end the adolescent AIDS epidemic — A progress report. Available at: on 5th December 2018.
[11]  UNICEF. 2015. Progress for children. New York. Available at: Assessed on 7th October 2018.
[12]  UNAIDS.2016.All in: end adolescent AIDS. Available at: http://wwwunaidsorg/sites/default/files/media_asset/20150217_ALL_IN_brochurepdf. Assessed on 18th October 2018.
[13]  Mburu G, Hodgson I, Teltschik A, Ram M, Haamujompa C, Bajpai D, et al. Rights-based services for adolescents living with HIV: adolescent self-efficacy and implications for health systems in Zambia. Reprod Health Matters. 2013; 21(41):176-85.
[14]  Napierala Mavedzenge S, Newman JE, Nduwimana M, Bukuru H, Kariyo P, Niyongabo T, et al. HIV infection among children and adolescents in Burundi, Cameroon, and the Democratic Republic of Congo. AIDS Care. 2017;29(8):1026-33.
[15]  UNAIDS. 2014. 90‐90‐90: an ambitious treatment target to help end the AIDS epidemic. Available at: Assessed on 12th November 2018.
[16]  Fonsah JY, Njamnshi AK, Kouanfack C, Qiu F, Njamnshi DM, Tagny CT, et al. Adherence to antiretroviral therapy (ART) in Yaoundé-Cameroon: association with opportunistic infections, depression, ART regimen and side effects. PloS one. 2017; 12(1): e0170893.
[17]  O’Bryan G. Factors associated with ART non-adherence and contributing influence of stock shortages at Nkongsamba Regional Hospital, Cameroon.Global health. 2015; [264].
[18]  Pefura Yone EW, Soh E, Kengne A, Balkissou A, Kuaban C. Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteria. PLoS One. 2017; 12(1).
[19]  Meresse M, March L, Kouanfack C, Bonono RC, Boyer S, Laborde-Balen G, et al. Patterns of adherence to antiretroviral therapy and HIV drug resistance over time in the S tratall ANRS 12110/ESTHER trial in C ameroon. HIV medicine. 2014; 15(8): 478-87.
[20]  NACC. 2014. Global Aids Response Progress (GARP). Available at: http://wwwunaidsorg/sites/default/files/country/documents/CMR_narrative_report_2014pdf. Assessed on 6th October 2018.
[21]  Maddali MV, Gupta A, Shah M. Epidemiological impact of achieving UNAIDS 90-90-90 targets for HIV care in India: a modelling study. BMJ Open. 2016;6(7):e011914.
[22]  CNLS. 2016. Annual report. Available at: http://wwwcnlscm. Assessed on 2th December 2018.
[23]  Rongkavilit C, Wright K, Chen X, Naar-King S, Chuenyam T, Phanuphak P. HIV stigma, disclosure and psychosocial distress among Thai youth living with HIV. Int J STD AIDS. 2010;21(2):126-32.
[24]  Marima R. The Prevalence and factors associated with nonadherence with ARV treatment and cotrimoxazole preventive therapy among HIV infected adolescents attending out-patient HIV clinics in Kenya. Aku institutional repositiry. 2011.
[25]  Naswa S, Marfatia YS. Adolescent HIV/AIDS: Issues and challenges. Indian J Sex Transm Dis AIDS. 2010;31(1):1-10.
[26]  {Chhim, 2018 #371}
[27]  MINSANTE. Cameroon Population-Based HIV Impact Assessment. Available at: SS_A4_v13_requests_7.25.18.pdf. Assessed on 7th November 2018.
[28]  Joshi KS, Bhaware BD, Pazare AR. Indian Adolescent Living with HIV-AIDS: Current Clinical Scenario. Journal of The Association of Physicians of India. 2017;65:41.
[29]  Mellins CA, Tassiopoulos K, Malee K, Moscicki AB, Patton D, Smith R, et al. Behavioral health risks in perinatally HIV-exposed youth: co-occurrence of sexual and drug use behavior, mental health problems, and nonadherence to antiretroviral treatment. AIDS Patient Care STDS. 2011;25(7):413-22.
[30]  MacPherson P, Munthali C, Ferguson J, Armstrong A, Kranzer K, Ferrand RA, et al. Service delivery interventions to improve adolescents' linkage, retention and adherence to antiretroviral therapy and HIV care. Tropical Medicine & International Health. 2015; 20(8): 1015-32.
[31]  Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. Aids. 2014;28(13):1945-56.
[32]  Davies MA, Boulle A, Fakir T, Nuttall J, Eley B. Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study. BMC Pediatr. 2008; 8(34): 1471-2431.