Adherence to ARV among children and young people (15-24 years) in the South West Region (SWR) of Cameroon: comparing the self-report assessment scale (MMAS-4) and virtual analogue scale (VAS) in predicting viral suppression.

Abstract

Background

 Optimal antiretroviral therapy (ART) adherence is mandatory to optimize patient outcomes.   Poor ART adherence and worse treatment outcomes have been observed in children and adolescents. Diverse subjective methods are used to assess adherence in the absence of a gold standard method but there is limited information on effective methods in measuring ART adherence in this vulnerable population.

Objectives: This study assessed ART adherence using two self-reported methods and compared their ability to predict viral suppression.

Method

A facility-based cross-sectional and retrospective study was conducted in which 329 participants were consecutively recruited into the study between February to June 2023. A structured questionnaire was used to capture socio-demographic and treatment variables. Two self-report scales (MMAS-4 and VAS) and the viral load suppression were used in parallel to assess ART adherence in 329 participants after non-adherence was normalized to minimize social desirability effects. The Kappa statistics test and the Kendall’s Wa concordance tests were used to determine the agreement between the three measures.

Results: The adherence levels determined by the three methods; (self-report MMAS-4; VAS and Viral suppression) were, 70.5%, 69.0 %, and 71.5 % respectively. Based on Kappa statistics, the level of agreement between the adherence methods was poor; SR and VAS (Kappa=0.402, p<0.001), VL and SR (Kappa=0.201, p<0.001), VL and VAS (Kappa=0.352, p<0.001). SR and VAS had a better agreement seconded by VL and VAS. Respondents who had good ART adherence on VAS were 40 times as likely to achieve Viral Suppression.

Conclusion: ART adherence among children and young people in the South West Region was below the expected 95%. The level of agreement among adherence methods was poor with the highest agreement observed between the two subjective methods and least between the subjective and objective methods.

Keywords: HIV in children, young people, adolescents, adherence, self-reported adherence, viral load.