The outcome of intervention, characteristics, and determinants of treatment failure in HIV-infected adolescents on first-line antiretroviral therapy at a tertiary health institution, in South-east Nigeria

Abstract

Background: The adolescent phase of life is characterized by the desire for independence, experimentation, and heightened peer influence. These may affect HIV prevention, care, treatment, and support in adolescents. Objective: This study was aimed at determining the outcome of intervention and factors responsible for treatment failure among adolescents on first-line antiretroviral therapy (ART). Materials and Methods: It was an interventional cohort study that studied 88 adolescents on ART. An interviewer-administered questionnaire was used to collect the data on sociodemographics. Assessment of adherence was done by pill count and self-reports. Reverse transcriptase polymerase chain reaction was used to quantify the amount of HIV RNA in participants. Results: A total of 22 (25.0%) out of 88 adolescents had viral load assays of ≥1000 copies/ml despite being on first-line ART for a mean period of 5.70 ± 3.21 years. After enhanced adherence counselling (EAC) of three months, 10 (44.5%) of the 22 adolescents achieved viral suppression (<1000 copies/ml). Being tired of taking drugs was the major reason (41.1%) for non-adherance to ART. There were significant relationships between treatment failure and age (P = 0.010), gender (P = 0.024), socio-economic class (P = 0.020), orphan status (P = 0.010), type of ART (P = 0.008), HIV status disclosure (P ≤ 0.001), and sexual experience in the adolescent (P ≤ 0.001). Conclusion: Viral suppression rate after EAC was low. There is a need to address modifiable factors that influence viral non-suppression in adolescents through adolescent-friendly and responsive services geared toward counselling, skill acquisition, and empowerment to help adolescents navigate this stage of life.

Keywords

• adolescent
• antiretroviral therapy
• hiv infection
• treatment failure