Caregiver role in HIV medication adherence among HIV-infected orphans in Tanzania

ABSTRACT

Youth living with HIV in sub-Saharan Africa face numerous challenges in adhering to HIV treatment. The AIDS epidemic has left many of these youth orphaned due to AIDS-related death of one or both parents. It is imperative to understand the family context of youth living with HIV in order to develop responsive interventions to improve adherence to antiretroviral therapy. We conducted qualitative in-depth interviews with 17 HIV-infected AIDS orphans, ages 13–24 years, screened positive for mental health difficulties according to the Patient Health Questionaire-9 (PHQ-9) or UCLA PTSD Reaction Index (PTSD-RI), and receiving outpatient HIV care at an adolescent medical clinic in Moshi, Tanzania. Treatment-related support varied by orphan status. Paternal orphans cared for by their biological mothers and maternal orphans cared for by grandmothers described adherence support such as assistance taking medication and attending clinic. Double orphans did not report adherence support. Several maternal and double orphans faced direct interference from caregivers and household members when they attempted to take their medications. Caregivers play a significant role in treatment adherence and must be considered in interventions to increase medication adherence in HIV-infected orphans. Findings from this study informed caregiver participation in Sauti ya Vijana (The Voice of Youth), a mental health intervention for youth living with HIV in Tanzania.

KEYWORDS:

• HIV-infected
• AIDS orphan
• adolescent
• medication adherence
• caregiver

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by the Duke University Center for AIDS Research (CFAR), an NIH funded program [grant number P30 AI064518], the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) training grant to the Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center [grant number T32 HD060558] and by NIH Research Training Grant R25 TW009337 and International Scientist Research Development Award [grant number K01 TW-009985] funded by the Fogarty International Center and the National Institute of Mental Health (to DED). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.