Page 189 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 6 of 7 Original Research

Adolescent-friendly HIV services that could be mirrored at implementation level between the
school and the clinic.
Our study found health systems barriers to ART adherence
in the form of long waiting times and missing or misplaced Interventions to improve adherence should address
files, and the risk of inadvertent disclosure of HIV status.
These barriers have been reported previously and are psychosocial factors such as treatment fatigue, depressive
not unique to adolescents. 19,20,21,22 Literature recommends the symptoms, disclosure and family and household dynamics
integration of youth-friendly services such as evening amongst adolescents. In other facilities in the Western
clinics, adolescent clinic days and youth-friendly waiting Cape province, family clinics and youth clubs have been
areas within ART programmes. 23 implemented to boost adherence. Future studies should seek
to explore how these initiatives could be mainstreamed
across all facilities in the province.
Reconciling adolescence and taking medicine
All participants reported treatment fatigue as a barrier to Limitations of the study
adherence. Participants in this study were frustrated that the
treatment routine was extremely rigid and that no leniency This study is of limited scope, because it was conducted
was allowed. This is in keeping with the literature that towards the fulfilment of requirements for a master’s degree
identified treatment fatigue as a major factor impacting on with coursework. The sample size was relatively small, and
older adolescents’ ability to remain adherent to a treatment data saturation was not achieved. The sample was drawn
regimen. There was a suggestion from the older adolescents from adolescents who were still in care; therefore, some
24
in this study that having ART-free weekends would greatly measure of adherence was present. Valuable lessons about
improve their adherence. adherence challenges might be missed because those who
25
defaulted from treatment were not included in the study.
The nature of disclosure remains a pivotal role in ART
adherence as also reported in this study. The participants in Acknowledgements
this study preferred selective disclosure where they chose to
disclose their HIV status to some people but not to others, Competing interests
which is in line with the current WHO guidelines. Our The authors declare that they have no financial or personal
4
study found that participants reported improved adherence relationships that may have inappropriately influenced them
once their HIV status had been disclosed to them and they in writing this article.
have disclosed their HIV status to supportive friends. These
findings are congruent with the literature that says if Authors’ contributions
adolescents disclose their status to a trustworthy person or
people, they are more likely to receive help in the form of L.-A.C.D. conducted the research and wrote the first draft.
knowledge and resources to help them cope with a HIV B.E.v.W. supervised the research, revised subsequent drafts
diagnosis and to access and remain in HIV care. 4,26 and finalised the manuscript. All authors approved the final
version of the manuscript.
Our study found indications of depressive symptoms
through participants reporting feelings of being alone and Funding
dirty (self-stigma) and contemplating ending their lives.
This finding is consistent with the literature that reports This research received no specific grant from any funding
higher prevalence of emotional and behavioural problems agency in the public, commercial or not-for-profit sectors.
amongst adolescents living with HIV compared to other
high-risk groups. 27,28 A meta-analysis reports that patients Data availability statement
with depressive symptoms were 42% less likely to achieve
optimal adherence to ART regimen. 29 Data sharing is not applicable to this article as no new data
were created or analysed in this study.
Conclusion
Disclaimer
This study highlighted the complexity of ART adherence in
the midst of juggling school, home life and personal life The views and opinions expressed in this article are those of
goals and aspirations amongst a sample of school-going the authors only.
adolescents on ART in a low socio-economic urban township
in the Western Cape. Whereas it was encouraging that the References
adolescents were all in school, the lack of collaboration
between the education sector and the health sector in the 1. UNICEF. Current status and progress: Turning the tide against AIDS will require
interest of the adolescent and learner’s adherence to treatment more concentrated focus on adolescents and young people [homepage on the
Internet]. 2017[cited 2017 Aug 18]. Available from: https://data.unicef.org/topic/
is of great concern. More research is needed to unpack the hivaids/adolescents-young-people/#
complexity of this intersection and to develop guidelines for 2. Cotton M, Jaspan H, Li R, Nattrass N, O’Brien V, Rabie H. Positive futures: A qualitative
study on the needs of adolescents on antiretroviral therapy in South Africa. AIDS
integration and collaboration between these two sectors Care. 2010;60(22):751–758. https://doi.org/10.1080/09540 120903431363

http://www.sajhivmed.org.za 182 Open Access