Page 185 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 2 of 7 Original Research

do access ART, adherence and retention in care and The majority of the youth who access this facility come from
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treatment outcomes are poorer compared to adults. the high school and primary school that are adjacent to the
facility and utilised the clinic facilities before or after school.
Poor adherence to ART is one of the most significant The number of adolescents who access the clinic for ART
challenges in ensuring patients achieve and maintain viral and HIV care is not known because routine HIV data are
load suppression. Factors associated with poor adherence reported for paediatric (under 15 years) and adult (15 years
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have been categorised as patient-related, structural, provider- and older) patients. The study was conducted from February
related, disease-related, medication-related or psychological to April 2016.
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barriers. For adolescents, the transitional life period is
characterised by physiological, psychological and intellectual
development, which poses very unique challenges to Study design
ART adherence. The management of adolescents on ART, An exploratory qualitative design was employed, because
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therefore, has to take cognisance of the complexity of ART adherence is considered a very complex phenomenon
biological and psychosocial changes which take place in the and requires an in-depth understanding of the socio-cultural
life of adolescents and its effects on adherence. 9,10,11 as well as the biological environment in which the behaviour
occurs.
Research problem
It is posited that, amongst others, the reason for the poor Study population and sampling
adherence amongst adolescents (15–19 years) is because the Adolescents between 10 and 19 years who were registered to
transition from paediatric to adult HIV care programme is receive ART at the primary health care clinic in 2015–2016
not well managed. However, there is a paucity of behavioural and who were on ART for at least 6 months constituted the
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research to give insights into what the challenges and barriers target study population and were subjected to purposive
are that adolescents with HIV face when receiving treatment sampling. The inclusion criterion of 6 months on ART was
in the adult ART programme. 10
chosen, because we wanted to explore participants’ adherence
behaviour and experience on ART. Twenty-six participants
Research aim were identified as eligible for inclusion to the study from

The aim of the study was to describe challenges to living with their clinic files. However, only 15 participants were reachable
HIV and adherence to ART amongst school-going adolescents and consented to participate in the study. Socio-demographic
who receive ART at a public primary health care clinic in characteristics such as age and sex, clinical characteristics
2015–2016 in a low economic urban setting in the Western such as indications of adherence and initiation date of ART
Cape province of South Africa. were extracted from patient folders to identify eligible
participants. A summary of characteristics of adolescent
Methodology participants is presented in Table 1. Participants’ adherence

Study setting was identified as ‘poor’ or ‘good’ from the doctor’s notes in
the patient folder. All participants in the study were
This study took place at a municipal primary health care perinatally infected.
clinic in an urban residential area (township) in the greater
Cape Town area, where the participants received HIV Data collection
treatment services. The township is home to a predominantly
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African community. During the previous political regime Data were collected through four focus group discussions
(apartheid), this community was largely marginalised (FGDs) and eight individual interviews in a language of the
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and exploited. The area spans 13.46 km and has a total participants’ choice, that is, English or isiXhosa. All data
population of 64 269, of which 96.3% are African people,
2.7% are mixed race people and 0.2% are white people. It is TABLE 1: Characteristics of adolescent participants (N = 15).
part of the Cape Town metro that carries the heaviest burden Variables Number of participants
of HIV disease in the Western Cape with a prevalence of Age (years)
5.2% in 2012. 10–14 7
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15–19 8
The clinic provides immunisation services, care for sick Sex
babies, TB treatment for drug susceptible and drug-resistant Male 6
TB and HIV care for adults and children (wellness care and Female 9
ART). It also provides antenatal care and family planning Years of ART 6
6 months–1 year
services. The clinic is open Monday to Friday from 07:30 to More than 1 year 9
16:30. The clinic is staffed by a pharmacist, two resident Reported adherence
doctors, nurses, admin staff and a psychologist who comes to Good 9
the clinic once a week. No dedicated adolescent services are Poor 6
provided. ART, antiretroviral therapy.

http://www.sajhivmed.org.za 178 Open Access