Barriers to HAART adherence in a cohort of adolescents in urban Uganda

Background: Many HIV positive adolescents in the developing world now have access to highly active antiretroviral therapy (HAART), and near-perfect adherence is required for optimal benefit. African adolescents may face unique barriers to medication adherence, which have been underrepresented in the literature. Methods: This study investigated adherence barriers among perinatally-infected Ugandan adolescents. Patients aged 10-20 (average 15.21) from a Kampala clinic where care and HAART were provided free were interviewed in July or August 2006. Adherence was assessed using patient self-report. Patients completed a structured questionnaire about common barriers. Opportunity for open response was offered. 72 patients were included in the analysis using SPSS 11.0. Results: 82% of patients reported ‘adherence' (at 95% or better) using a 30-day visual analog scale. 90% of patients responded that they had someone at home helping them to maintain adherence. Significant barriers included: simply forgetting (39%), being away from home, (30%), sleeping through dose time (22.5%), and insufficient food (18%). An additional 7 (10%) patients, while denying this barrier in the yes/no question, said that lack of food prevented or delayed them taking their medication in the open response. Conclusions: Even where HAART is provided free, adolescents face significant barriers to medication adherence. Many lack sufficient nutritional support and fail to take their medication properly when they are hungry. This study demonstrates that social support continues to be important in the provision of HIV/AIDS care to adolescents, and adds to the growing body of evidence establishing the importance of food in HIV/AIDS treatment.