Background: Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan\nAfrica. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART\nadherence among children and teenagers in rural Tanzania.\nMethods: We applied a sequential explanatory mixed method design targeting children and teenagers aged 2ââ?¬â??19\nyears residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining\nfocus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined\noptimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic\nregression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored\nissues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was\nanalysed using thematic content analysis.\nResults: Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the\naverage adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the\nqualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity,\nbeing unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and\nforgetfulness were seen to be barriers for optimal adherence.\nConclusion: The study has highlighted specific challenges in ART adherence faced by children and teenagers.\nHaving a biological parent as a caretaker remains a key determinant of adherence among children and teenagers.\nTo achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system\nneed to be designed.
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