Adolescence and the risk of ART non-adherence during a geographically focused public health intervention: an analysis of clinic records from Nigeria

Spreckelsen, T. F. , Langley, M., Oluwasegun, J. I., Oliver, D., Magaji, D. and Haghighat, R. (2022) Adolescence and the risk of ART non-adherence during a geographically focused public health intervention: an analysis of clinic records from Nigeria. AIDS Care, 34(4), pp. 492-504. (doi: 10.1080/09540121.2021.1969331) (PMID:34445904)

Abstract

The risk of poor antiretroviral therapy (ART) adherence among adolescents is a challenge to controlling HIV. This study aims to provide guidance for geographically focussed public health interventions to improve adherence. Through clinic records, it investigates adolescents’ non-adherence risk and clinic-level differences in regions of Nigeria which were part of PEPFAR’s geographical pivot. Records (n = 26,365) were selected using systematic random sampling from all PEPFAR-supported facilities (n = 175) in targeted Local Government Areas across three regions in Nigeria. Adolescents’ risk of non-adherence was estimated using region-specific random-effects models accounting for clinic-level variation. These were adjusted for sex, whether a patient had to travel to a different region, clinic location (urban/rural), clinic type (primary, secondary, tertiary). Despite regional variations, adolescents were at higher risk of non-adherence compared to adults. A similar, but weaker, association was found for children. Patients attending tertiary facilities for ART in the South-South region exhibited very high risk of non-adherence. Adolescents and children are at an increased risk of poor ART adherence in rural regions of Nigeria. Regional differences and facility type are critical factors. Future public health programmes focused on the risk of poor adherence targeting “high-prevalence areas” should be sensitive to contextual differences and age-appropriate care.

• Item Type: Articles
• Additional Information: This paper has been made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement [AID-OAA-A-14-00061].
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Spreckelsen, Dr Thees
• Authors: Spreckelsen, T. F., Langley, M., Oluwasegun, J. I., Oliver, D., Magaji, D., and Haghighat, R.
• Subjects: H Social Sciences > HN Social history and conditions. Social problems. Social reform; H Social Sciences > HV Social pathology. Social and public welfare; R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine; R Medicine > RJ Pediatrics > RJ101 Child Health. Child health services
• College/School: College of Social Sciences > School of Social and Political Sciences > Sociology Anthropology and Applied Social Sciences
• Journal Name: AIDS Care
• Publisher: Taylor & Francis
• ISSN: 0954-0121
• ISSN (Online): 1360-0451
• Published Online: 26 August 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in AIDS Care 34(4): 492-504
• Publisher Policy: Reproduced under a Creative Commons License

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