ART Adherence Among Youth In Rwanda: The Importance of Depression and Trauma

In Sub-Saharan African HIV-positive youth begin treatment earlier and live longer, spending more time on antiretroviral treatment (ART) than adults, and increasing risk of treatment failure. Adherence to ART is critical to ensure life-extending benefits of treatment and reduce HIV transmission (treatment-as-prevention). Women's Equity in Access to Care and Treatment provides comprehensive HIV care in Kigali, including 208 youth aged 12-24 on ART.

Clinic staff conducted psychosocial assessments and adherence surveys with 109 youth aged 12-24. Of these, 28 youth aged 18-24, were interviewed and classified as 9 good, 10 intermediate, and 9 poor adherers. In staff-led focus groups, good and poor adherers shared obstacles and success strategies. In staff-led workshop, 21 youth on second-line ART were confidentially surveyed on duration of second-line, sexual activity, disclosure, and adherence. Youth then identified obstacles and proposed solutions in staff-facilitated discussion.

61.5% of youth self-reported non-adherence (adherence <95%). Non-adherence was significantly associated with being informed about HIV status at later age, sexual abuse, depression, and parental loss. For those on second-line ART, top reasons for missing doses in past week were: 1) tired of taking medications (47.6%), 2) felt like they were taking too many medications (42.8%), and 3) felt too depressed to take medications (33.3%). Interviews and focus groups supported these findings, and revealed fear of stigma as another obstacle to adherence.

Current strategies to support ART adherence among Rwandan youth are insufficient. Interventions must address depression and trauma to create a clinically youth-friendly environment to improve adherence.