Adherence and retention studies of HIV-positive adolescents in Southeastern Nigeria and factors responsible for their outcomes: a quantitative and qualitative study

Adolescents living with HIV have an increasing burden of AIDS-related illnesses and death. Studies in other countries showed poor adherence to antiretroviral therapy (ART) and retention-in-care among this group. Limited studies exist in Nigeria on this subject. This cross-sectional study therefore assessed the level of adherence to ART and retention-in-care by HIV-positive adolescents in South-East Nigeria and the factors responsible for their outcomes, using a mixed methods approach. The study states and the interview participants were selected using convenient and purposive techniques, respectively. A multistage sampling technique was used for the selection of the study hospitals. The data for the quantitative study were from eligible patients' folders. For the qualitative studies, face-to-face in-depth interviews and key informant interviews were conducted on purposively selected HIV-positive adolescents and healthcare staff, respectively. Quantitative and qualitative data were analysed descriptively and thematically, respectively. The result showed that only 34.7% of the 147 HIV-positive adolescents assessed achieved ≥ 95% adherence to ART, and 72.2% were retained-in-care in 2016. The adherence level was not affected by the demographic variables and was not statistically different in the study states. Poverty was the major constraint, and improved working conditions were a major facilitator to the study outcome measures identified. HIV-positive adolescents in South-East Nigeria had poor adherence to ART (34.7) %, and a somewhat poor retention-in-care (72.2) %. The findings are worse than the reported poor global level of 62% adherence to ART and 85% retention-in-care. Service delivery interventions using the identified factors will improve these outcomes.