Adherence is affected by concurrent mental health issues or substance abuse, and we know that ‘risk behaviours’ are increased in youth living with chronic disease, (JC Suris Texas al, 2007 J Begent CHIVA 2010). The brain undergoes much change during the adolescent years and complete prefrontal cortex maturation isn’t complete until the 3rd decade. Studies have shown by the age of 25, adherence increases greatly – once impulse control, planning and emotional regulation have been established.
But what can we do to try and improve adherence to subsequently reduce the negative short- and long-term sequelae? The slide below shows some of the tried and tested behavioural adherence interventions which have proven to be effective both in adults and adolescents.
Beyond such interventions we are starting to consider alternative methods of ARV administration. Similar to how we consider contraception, for example LARC (long acting reversible contraception), injectables and implants could be used to administer therapy, and thus remove the risk of low adherence. Other considerations are around short cycle therapy/‘weekend holidays’ and oral therapy with a high barrier to resistance.
As practitioners, we need to accept that despite all our efforts to help, support and guide adolescents, there are likely to be as many as 20% that will continue to have reduced adherence with possible short- and long-term complications as a result. In Cairns, QLD the number of adolescents living with HIV is relatively small compared with some parts of the world, but perhaps building a peer support group specifically for adolescents (<25 years) could still be a useful way to reach this group. Also, since the transition between paediatric and adult care occurs around this vulnerable time (age 16-18 years), good communication between the two multidisciplinary teams is vital, and this transition may need to occur over several months to iron out any initial blips
Author bio:
Charlie is an East London trained GP with a special interest in Sexual and Reproductive Health. She currently works at Cairns North Sexual Health Clinic as a GP, and an HIV s100 prescriber.
