Abstract #180  -  Challenges of adherence to antiretroviral treatments in youths living with HIV since birth
Authors:   Presenting Author:   Professeure Mylène Fernet - Université du Québec à Montréal
Additional Authors:  Madame  Marie-Eve  Richard, Professeure  Joanne  Otis, Professeur  Joseph Josy Lévy, Dr Normand  Lapointe, Madame Johanne  Samson, Madame  Guylaine Morin, Madame  Kimberly Wong, Professeure Jocelyne Thériault, Professeur Germain  Trottier,
Aim: Studies on adherence to antiretroviral treatments have identified adolescence as an important period where treatment responsibility, previously assumed by parents, must be integrated by youths. The recommended 95% threshold of antiretroviral treatment adherence varies between 22% and 84% in children, adolescents and young adults living with HIV. The principal adherence difficulties are associated with the treatment itself, the stage of HIV advancement and the patients characteristics. This study explores how issues related to adherence evolve during the adolescent period.
Method / Issue: Within a qualitative chronological (longitudinal) research framework, 18 youths aged 13 to 22 years participated twice in individual semi-directed interviews within a three year interval at the Centre Maternel et Infantile sur le Sida du CHU Sainte-Justine in Montreal, Canada. At the second interview, 11 youths were under treatment, 7 had stopped their treatment and of these 7, 2 had given up their medical follow up. Lastly, six are now followed in adult clinics.
Results / Comments: At time 1, three groups of youths were identified: youths that reported adherence difficulties, youths that reported good adherence and youths off treatment. For youths reporting adherence difficulties, the medication becomes an indicator which differentiates them from their peers and also puts their willpower to the test. The difficulties are associated with side effects as well as the galenic form and youths have few means to facilitate taking medication. The youths that report a good adherence see the medication as life saving and the difficulties involve occasional involuntary memory lapses caused by time and schedule constraints. Diverse strategies are put in place to facilitate the taking of medication such as seeking out support from his/her entourage or the use of a pill-organiser. At time 2, we observed that when treatment changes bring about undesirable side effects or when they imply a heavier posology and when they occur at the same time as the transfer to the adult clinic, numerous participants are shown to have adherence difficulties and will eventually stop their treatment. A resumption of treatment (after a supervised cessation) or treatment changes that imply a less heavy posology or minor secondary effects seem to facilitate adherence to treatment. Participants who did not have a change in treatments between T1 and T2 maintain good adherence, suggesting that the medication has a meaning to them and that they had developed strategies for difficulties they have faced.
Discussion: Over time, the support of their entourage and the search for autonomy and independence facilitates the adolescents� process of adhesion but this can be threatened by the repercussions of side effects and treatment constraints.
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