The role of self-efficacy in HIV treatment adherence and its interaction with psychosocial factors among HIV positive adolescents in transition to adult care in Kenya

ABSTRACT

Adolescents and young adults (15–24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16–19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p < 0.001 and p = 0.001), respectively. The paramed test indicated that the association between self-efficacy and adherence was mediated by self-esteem with a total effect of OR 6.93 (bootstrap 95% CI 1.99–24.14). Adherence self-efficacy was also mediated by self-esteem in developing adherence behavior. Interventions focused on increasing adherence among ALWHIV should include self-esteem building components.Key words : Adolescents, Adherence self -efficacy, Transition , perinatal,

Acknowledgments

We want to thank the adolescents at Mbagathi hospital who participated in this study. The leadership and staff at Mbagathi hospital, in particular Lilian Abonyo. The study staff included Brenda Anundo and Veronica Mwania for their diligence.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

Support for this project was by the Fogarty International Center of the National Institutes of Health (NIH) under Award Number D43TW009343 and the University of California Global Health Institute (UCGHI). The content is solely the authors’ responsibility and does not necessarily represent the official views of the NIH or UCGHI. The authors declare no conflict of interest. The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation

Notes on contributors

Nyawira Gitahi

NGK, and EB, developed the research concept, NGK, BA, and VM collected data, SM analyzed the data, NGK, EB, PM and SM provided input and EB, NGK and PMcritically reviewed the manuscript.