ART adherence care strategies among adolescents living with HIV in Ghana's Ashanti Region: a qualitative study

Résumé

Adolescents living with HIV (ALHIV) in sub-Saharan Africa carry a disproportionate share of the regional epidemic and consistently record poorer adherence to antiretroviral therapy (ART) than adults. While the statistical correlates of non-adherence are well documented, the everyday strategies adolescents devise to keep themselves on treatment remain comparatively understudied in Ghana. This study explored the ART adherence care strategies of ALHIV in the Ashanti Region, with a view to informing implementable, adolescent-responsive service models. This was the qualitative strand of a convergent parallel mixed-methods study whose quantitative strand surveyed a census of 515 adolescents and recorded 92% self-reported adherence. Twenty-four adolescents aged 14–19 years, all with perinatally acquired infection and all of whom had received documented full disclosure of their HIV status before recruitment, took part in three mixed-sex focus group discussions of eight participants each, one at each of a teaching hospital, a regional hospital, and a district hospital. Discussions lasted approximately 60 min, were conducted in Asante Twi without caregivers present, audio-recorded with consent, transcribed verbatim, independently translated into English with verification against the recordings, and analyzed using inductive thematic analysis in NVivo with independent peer coding and member checking. The Information-Motivation-Behavioral Skills (IMB) model framed the interpretation. Four themes were generated: ART reminder strategies, comprising social support, routine activity cues, and mobile phone or watch alarms; stigma and concerns about privacy, comprising concealment practices and unease about HIV public education campaigns that display ART packaging; emotional and psychological impact, centring on acceptance and coping through counseling; and motivation and commitment to treatment, comprising personal goals and a desire for good health. Adolescents combined family reminders, daily routines, and concealed pill containers to protect both adherence and anonymity, while counseling and future aspirations sustained long-term commitment. Ghanaian adolescents are active managers of their own treatment rather than passive recipients of care. Service delivery should formalize the informal strategies adolescents already use, strengthen confidential reminder and counseling supports, and revise public messaging so that awareness campaigns do not inadvertently disclose status.

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