Equity in adherence to antiretroviral therapy among economically vulnerable adolescents living with HIV in Uganda

ABSTRACT

Studies from sub-Saharan Africa indicate that children made vulnerable by poverty have been disproportionately affected by HIV with many exposed via mother-to-child transmission. For youth living with HIV, adherence to life-saving treatment regimens are likely to be affected by the complex set of economic and social circumstances that challenge their families and also exacerbate health problems. Using baseline data from the National Institute of Child and Human Development (NICHD) funded Suubi+Adherence study, we examined the extent to which individual and composite measures of equity predict self-reported adherence among Ugandan adolescents aged 10–16 (n = 702) living with HIV. Results showed that greater asset ownership, specifically familial possession of seven or more tangible assets, was associated with greater odds of self-reported adherence (OR 1.69, 95% CI: 1.00–2.85). Our analyses also indicated that distance to the nearest health clinic impacts youth’s adherence to an ARV regimen. Youth who reported living nearest to a clinic were significantly more likely to report optimal adherence (OR 1.49, 95% CI: 0.92–2.40). Moreover, applying the composite equity scores, we found that adolescents with greater economic advantage in ownership of household assets, financial savings, and caregiver employment had higher odds of adherence by a factor of 1.70 (95% CI: 1.07–2.70). These findings suggest that interventions addressing economic and social inequities may be beneficial to increase antiretroviral therapy (ART) uptake among economically vulnerable youth, especially in sub-Saharan Africa. This is one of the first studies to address the question of equity in adherence to ART among economically vulnerable youth with HIV.

KEYWORDS:

• Equity
• HIV
• youth
• Uganda
• ART adherence
• assets
• Suubi

Acknowledgements

The authors thank Prakash Gorroochurn, Associate Professor in the Biostatistics Dept. at Columbia University Mailman School of Public Health, for helpful guidance on statistical methods and comments on initial drafts of the manuscript. LGB, LJ, and FS conceptualized the paper structure. LGB lead data analysis for this paper, and drafted the manuscript. LJ contributed to data interpretation and drafting of the manuscript. FS is the PI for the Suubi + Adherence study, the parent grant on which the results presented here are based. FS conceptualized the Suubi + Adherence study, obtained funding for the study, and coordinated and supervised all aspect of the study implementation including instrumentation of the measures, data collection and data entry. CM and MM are co-investigators on the Suubi + Adherence study and both contributed to the conceptualization of the study. PN provided input and reviewed draft versions of the manuscript. All authors approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Research reported in this publication was supported by the National Institute of Child and Human Development (NICHD) under Award Number R01HD074949 (PI: Fred M. Ssewamala, PhD). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.