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. 2024 Jun 1;96(2):101-105.
doi: 10.1097/QAI.0000000000003400. Epub 2024 Feb 12.

Lower self-reported ART adherence among adolescents in boarding schools compared to day schools

Brenda Wandika  1   2 , Florence Nyapara  1 , Calvince Aballa  1 , Barbra A Richardson  2   3 , Dalton Wamalwa  4 , Grace John-Stewart  2   5   6   7 , Irene Inwani  1 , Irene Njuguna  1   2
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Lower self-reported ART adherence among adolescents in boarding schools compared to day schools

Brenda Wandika et al. J Acquir Immune Defic Syndr. .

Abstract

Introduction: Adolescents living with HIV (ALH) have poorer adherence to antiretroviral therapy (ART) than adults. Many ALH in sub-Saharan Africa (SSA) are enrolled in boarding schools where stigma is pervasive and may impact adherence.

Methods: We collected sociodemographic data, school information, medical history, and viral load (VL) data from ALH age 14-19 in 25 HIV clinics in 3 counties in Kenya. Using generalized estimating equations, we compared ART adherence in ALH attending day and boarding schools.

Results: Of 880 ALH, 798 (91%) were enrolled in school, of whom 189 (24%) were in boarding schools. Of those in school, median age was 16 (IQR: 15, 18), 55% were female, 78% had a parent as a primary caregiver, and 74% were on DTG-based ART. Median age at ART initiation was 6 years (IQR 3, 10).Overall, 227 (29%) ALH self-reported missing ART when school was in session (40% in boarding and 25% in day school). After adjusting for sociodemographic and HIV care characteristics, ALH in boarding schools were significantly more likely to self-report missing ART than those in day schools (adjusted Prevalence Ratio (aPR): 1.47, 95% CI 1.18, 1.83, p=0.001). Among 194 ALH, only 60% had undetectable (<20 copies/ml) HIV viral load (62% day schools and 51% boarding schools)(p=0.097).

Conclusion: ALH had high self-reported non-adherence overall, with worse adherence among those in boarding schools. Schools remain a critical untapped resource for improving ALH outcomes.

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Conflict of interest statement

Competing interests: Authors have no competing interests to disclose.

Figures

Figure 1:
Figure 1:
Reasons for missed ART and missed clinic visit by school type.
See this image and copyright information in PMC

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