Brief Report: Lower Self-Reported Antiretroviral Therapy Adherence Among Adolescents in Boarding Schools Compared to Day Schools

Abstract

Introduction: Adolescents living with HIV (ALH) have poorer adherence to antiretroviral therapy (ART) than adults. Many ALH in sub-Saharan Africa are enrolled in boarding schools where stigma is pervasive and may impact adherence. Methods: We collected sociodemographic data, school information, medical history, and viral load data from ALH aged 14–19 years in 25 HIV clinics in 3 counties in Kenya. Using generalized estimating equations, we compared ART adherence in ALH attending day and boarding schools. Results: Of 880 ALH, 798 (91%) were enrolled in school, of whom 189 (24%) were in boarding schools. Of those in school, the median age was 16 years (interquartile range: 15–18), 55% were female, 78% had a parent as a primary caregiver, and 74% were on DTG-based ART. The median age at ART initiation was 6 years (interquartile range: 3–10). Overall, 227 (29%) ALH self-reported missing ART when school was in session (40% in boarding and 25% in day school). After adjusting for sociodemographic and HIV care characteristics, ALH in boarding schools were significantly more likely to self-report missing ART than those in day schools (adjusted prevalence ratio: 1.47, 95% CI: 1.18 to 1.83, P = 0.001). Among 194 ALH, only 60% had undetectable (<20 copies/mL) HIV viral load (62% day schools and 51% boarding schools; P = 0.097). Conclusions: ALH had high self-reported nonadherence overall, with worse adherence among those in boarding schools. Schools remain a critical untapped resource for improving ALH outcomes.