Treatment outcomes among adolescents receiving antiretroviral therapy, in Amhara Region, Ethiopia: a mixed method study
- Publication Type:
- Thesis
- Issue Date:
- 2023
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𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Despite effective human immunodeficiency virus (HIV), the virus remains a significant global health threat, with rising prevalence among Ethiopian adolescents over the last two decades. Adolescents living with HIV (ALHIV) face challenges accessing testing, treatment, and care due to limited awareness and various barriers. In Ethiopia, existing programs inadequately address adolescent needs, resulting in insufficient HIV treatment, adherence, and poor health outcomes. This thesis aims to examine the incidence rate and influential factors affecting antiretroviral therapy (ART) outcomes among ALHIV in Ethiopia.
𝗠𝗲𝘁𝗵𝗼𝗱𝘀: This thesis employed a mixed-methods approach, incorporating Ethiopian data spanning from 2005 to 2020. The first study involved a systematic review and meta-analysis (SRMA) that pooled the proportion of loss to follow-up (LTFU) among ALHIV in sub-Saharan Africa (SSA). The second study utilized interview data from ALHIV aged between 15 and 19 undergoing ART. The remaining studies relied on the retrospective medical records of ALHIV, who initiated ART in Ethiopia.
𝗥𝗲𝘀𝘂𝗹𝘁𝘀: Study I revealed a 15.07% LTFU among ALHIV in SSA, with a 43% higher risk for older adolescents. Study II identified stigma, mental health challenges, cultural beliefs, misinformation, and insufficient support as adherence barriers. Study III emphasized the critical role of adherence in achieving the 83% viral suppression rate among ALHIV. Study IV reported a 1.3 per 1,000 person-year death rate, with higher risks for those not attending school, having opportunistic infections, low hemoglobin, bedridden status, advanced clinical staging, or low CD4 counts. Poor ART adherence was linked to higher mortality risks, underscoring its importance in improving survival outcomes.
𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻𝘀: This thesis outlines challenges in ALHIV care in SSA, including a 15.07% LTFU. It emphasizes the vital role of connection and social support, while persistent barriers like stigma and mental health challenges necessitate targeted interventions. Despite progress, the viral suppression rate among Ethiopian ALHIV falls below the UNAIDS target of 90%, presenting an ongoing challenge. Path analysis highlights clinical conditions as mediators between good adherence and viral suppression, underscoring their positive associations. The study identifies a mortality rate of 1.3 per 1,000 person-years. Clinical factors like opportunistic infections and low hemoglobin levels raise the risk of death. On the other hand, not getting preventive therapy and not following through with ART are factors that can be changed that are linked to higher death rates.
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