Adolescents are a unique and sometimes neglected group in
the planning of healthcare services. This is the case in many parts of
sub-Saharan Africa, where more than eight out of ten of the world's
HIV-infected adolescents live. Although the last decade has seen a reduction in
AIDS-related mortality worldwide, largely due to improved access to effective
antiretroviral therapy (ART), AIDS remains a significant contributor to
adolescent mortality in sub-Saharan Africa. Although inadequate access to ART
in parts of the subcontinent may be implicated, research among youth with HIV
elsewhere in the world suggests that suboptimal adherence to ART may play a significant
role. In this article, we summarize the epidemiology of HIV among sub-Saharan
African adolescents and review their adherence to ART, emphasizing the unique
challenges and factors associated with adherence behaviour.
We conducted a comprehensive search of online databases for
articles, relevant abstracts, and conference reports from meetings held between
2010 and 2014. Our search terms included “adherence,” “compliance,”
“antiretroviral use” and “antiretroviral adherence,” in combination with
“adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term
“Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215
met inclusion criteria, and 148 were reviewed.
Adolescents comprise a substantial portion of the population
in many sub-Saharan African countries. They are at particular risk of HIV and
may experience worse outcomes. Although demonstrated to have unique challenges,
there is a dearth of comprehensive health services for adolescents, especially for
those with HIV in sub-Saharan Africa. ART adherence is poorer among older
adolescents than other age groups, and psychosocial, socio-economic,
individual, and treatment-related factors influence adherence behaviour among
adolescents in this region. With the exception of a few examples based on
affective, cognitive, and behavioural strategies, most adherence interventions
have been targeted at adults with HIV.
Although higher levels of ART adherence have been reported
in sub-Saharan Africa than in other well-resourced settings, adolescents in the
region may have poorer adherence patterns. There is substantial need for
interventions to improve adherence in this unique population.
Below: Map of Africa showing estimated number of adolescents aged 10 to 19 years living with HIV in Africa by country in 2013
Table 1
Number of people aged 0 to 14 years living with HIV and prevalence by sex among 20 to 24 year olds in 2013, by Joint United Nations Programme on HIV/AIDS
| Estimates of young people living with HIV, 2013 | ||||
|---|---|---|---|---|
| Region | Children and adolescents 0 to 14 years (% of total no.) with HIV | Estimated number living with HIV (all ages) | Percent of 20 to 24 year-olds with HIV (females) | Percent of 20 to 24 year-olds with HIV (males) |
| Sub-Saharan Africa | 2,900,000 (11.7) | 24,700,000 | 2.2 | 1.1 |
| Asia and the Pacific | 210,000 (4.4) | 4,800,000 | <0.1 | <0.1 |
| Caribbean | 17,000 (6.8) | 250,000 | 0.5 | 0.4 |
| Eastern Europe and Central Asia | 14,000 (1.3) | 1,100,000 | 0.2 | 0.2 |
| Latin America | 35,000 (2.2) | 1,600,000 | 0.1 | 0.3 |
| Middle East and North Africa | 16,000 (7.0) | 230,000 | <0.1 | <0.1 |
| Western and Central Europe and North America | 2800 (0.1) | 2,300,000 | <0.1 | 0.2 |
| GLOBAL | 3,200,000 (9.1) | 35,000,000 | 0.4 | 0.3 |
Joint United Nations Programme on HIV/AIDS (UNAIDS), Epidemic Monitoring and Analysis, Gap Report and 2013 estimates.
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1Department of Child and Adolescent Psychiatry, University College Hospital, Ibadan, Nigeria
2Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
3Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
4Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
5Division of Infectious Diseases, Northwestern University, Chicago, IL, USA
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