KEMAS 17 (3) (2022) 306-318

Jurnal Kesehatan Masyarakat

http://journal.unnes.ac.id/nju/index.php/kemas

Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

Nuraidah, Dessie Wanda

1,2 Masters Program in Nursing, Faculty of Nursing, University of Indonesia, Campus of the Faculty of
Medicine of the University of Indonesia, Indonesia
1 RSPI Prof.DR.Sulianti Saroso Jakarta, Indonesia

Article Info Abstract

Article History: Adherence on taking ARV drugs in adolescents is the main issue in the success of ARV
Submitted January 2020 treatment. ARV treatment is related to improving the quality of life in adolescents in-
Accepted December 2021 fected with HIV. Aim: To summarize the factors improving adherence on HIV medica-
Published January 2022
tion using ARV drugs in adolescents. Method: This article is a review of journal articles
Keywords: related to adherence on taking ARV drugs. Article reviewed were the articles on the past
Adherence, adolescent, five years, 2015-2019, with a search strategy involving the articles from the following da-
Antiretroviral, HIV/AIDS tabase including Science Direct, Scopus and ProQuest databases. Results: 12 articles re-
lated to adherence on ARV medication in adolescents. Conclusion: adherence is a signif-
DOI icant aspect that must be maintained in order to overcome the impact of non-compliance
https://doi.org/10.15294/ on ARV medication as it can affect the quality of life of adolescents with HIV / AIDS.
kemas.v17i3.23220

Introduction Living with HIV requires lifelong treat-

Human Immuno Deficiency Virus/ ment with ART and is associated with frequent
Acquired Immuno Deficiency Syndrome opportunistic infections, especially when
(HIV/AIDS) is a disease that attacks the human optimal adherence to ART is not achieved
immune system and is transmitted through (Kimera, et al., 2020). One of the measures
vertical and horizontal transmission (James, to reduce the symptoms of infection that
Nelson, & Ashwill, 2013). Based on data from appears is to give ARV drugs (Kementrian
the Joint United Nations Program on HIV and Kesehatan RI, 2014) with the aim of reducing
AIDS (UNAIDS) in 2018, the world population morbidity and mortality (Hornschuh, Dietrich,
affected by HIV in 2017 amounted to 36.9 Tshabalala, & Laher, 2017). Indonesia has a
million people. 1.8 million of them are new target of ending the AIDS epidemic as a public
infections (UNAIDS, UNAIDS Data 2018, health threat by 2030 (UNAIDS, 2018), with
2018). Data from the Ministry of Health (2019), Indonesia’s commitment to take a fast track
shows the cumulative number of HIV from 1987 approach 90-90-90 (Kementrian Kesehatan RI,
to June 2019 was 349,882 and who had AIDS 2019). In supporting the fast track approach,
were 117,064 people. There are 10,730 children health behaviors are needed in undergoing
aged 15-19 years who are infected with HIV ARV therapy, including adherence to treatment
and 3799 people who have AIDS. The highest (Holtzman, Brady, & Yehia, 2015).
risk factors for HIV/AIDS transmission were Adolescents are one of the age groups
heterosexual (70.2%), use of unsterile injection most affected by HIV. At this age there are
equipment (8.2%), homosexuality (7%) and changes both physically and psychologically
perinatal transmission (2.9%) (Kementrian so it is necessary to provide knowledge about
Kesehatan RI, 2019). the reproductive system, problems that occur


Correspondence Address: pISSN 1858-1196
Masters Program in Nursing, Faculty of Nursing, University of Indonesia, eISSN 2355-3596
Campus of the Faculty of Medicine of the University of Indonesia, Indonesia.
Email : [email protected]
Nuraidah, et all. / Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

in reproduction, the reproductive process important to know the factors that influence
and diseases that are transmitted through the therapy adherence. Adherence to ARV therapy
reproductive tract such as HIV. (Shaluhiyah, et in adolescents is influenced by many things
al., 2017). There is a fact that adolescents born that support and hinder in achieving the level
to be infected with HIV from their mothers, of adherence, so the authors are interested
for one reason there are still health workers in conducting a literature study related to
who do not provide good support to mothers adherence to ARV treatment in adolescents.
to prevent HIV transmission from mother to .
baby, even though the support of health workers Method
is very influential on maternal adherence to The search for articles was carried out
HIV treatment to prevent mother-to-child on October 12 – October 20, 2019 by searching
transmission of HIV (Isni, 2016). This must be electronic data. Searches were made on the
a concern for health workers so that the circle Science Direct, Scopus and ProQuest databases
of transmission can be broken. for articles in English using the keywords HIV/
Adherence to HIV treatment is a challe- AIDS; Adolescent*, Antiretroviral. Articles
nge, especially for adolescents, because the with research on adolescents with HIV/AIDS
course of illness in adolescents occurs during undergoing ARV therapy, but only discussing
the perinatal period and some adolescents do ARV adherence will be studied. The deadline for
not know their HIV status (Hornschuh, et al., publishing articles is determined for the last 5
2017). According to research (Denison, et al., years, namely 2015-2019. The inclusion criteria
2015) stated that if until adolescence a child in this literature search were 1). Articles related
does not know his HIV status, it can cause to adolescents with HIV/AIDS undergoing
non-compliance in taking ARVs because the ARV therapy, 2). Teenagers aged 9-19 years and
teenager does not know the side effects of their caregivers 3). Qualitative, quantitative or
the non-compliance. According to the World mixed method research articles 4). Fulltext and
Health Organization (WHO), an adolescent English articles published in 2015-2019. While
is someone aged 10-19 years old (Kementrian the exclusion criteria in the literature search
Kesehatan RI, 2018). Adolescents with HIV are 1). Adolescents with HIV who have other
who are undergoing ARV therapy must be comorbidities are such as type of literature
given good knowledge about HIV and ARVs review articles or systematic reviews.
in order to be obedient in undergoing therapy Based on the search results by entering
(Hornschuh, et al., 2017). The patient is said keywords obtained from Science Direct as many
to be compliant if the ARV taken reaches 95% as 1160 articles, Scopus as many as 9328 and
of the total drug given every month and can Proquest 27,924 for a total of 38,322 articles.
maintain its achievement (Kim, et al., 2014). After being screened based on inclusion and
Non-adherence to antiretroviral therapy (ART) exclusion criteria, 848 articles were obtained
continues to be the leading cause of treatment and after careful review, there were 12 articles
failure for people living with HIV (PLWHA) that matched the researcher’s goals. The
(Heestermans, et al., 2016), and increases the literature search strategy is shown in the form
risk of drug resistance and spreading the virus of a chart in Figure 1.
to others (Ssewamala, et al., 2019), so it is very

307
 KEMAS 17 (3) (2022) 306-318

Figure 1. Flowchart of the review of the article under study

308
Nuraidah, et all. / Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

309
KEMAS 17 (3) (2022) 306-318

310
Nuraidah, et all. / Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

311
 KEMAS 17 (3) (2022) 306-318

Results and Discussion (Okawa, et al., 2018). Stigma can occur in the
This literature study discusses 12 home environment (Ashaba, et al., 2019),
articles that have been selected to explore school environment and a place to play with
information about adolescent adherence to peers (Kariuki, Some, & Kimanthi, 2016).
ARVs. Adolescence is a transitional period Stigmatization by caregivers and other
marked by the development of puberty, the family members occurs as in the separation
formation of sexual identity and social and of household appliances and similar items
cognitive maturation (Mark, et al., 2017). Five (Ramaiya, et al., 2016). In addition, children
studies describe that most of the average age are treated unfairly and harshly, often being
of adolescents with HIV is in the age range of blamed if household chores are not done as
10-14.4 years (Bermudez, et al., 2016; DeSilva, expected. This treatment causes adolescents to
et al., 2018; Hudelson & Cluver, Lucie, 2015; feel unfairly loved by their parents/caregivers
Montalto, et al., 2017; Xu, et al., 2017). Five (Ashaba, et al., 2019). The HIV stigma attached
studies show that the majority of adolescent to him makes a lot of worries (Xu, et al., 2017).
girls who are infected with HIV (Bermudez, et Abusive treatment from peers and adults often
al., 2016; Firdu, Enquselassie, & Jerene, 2017; causes negative emotions, including feelings of
Montalto, et al., 2017; Okawa, et al., 2018; Xu, shame and emotional pain. To anticipate the
Munir, Kanabkaew, & Le Coeur, 2017). HIV/ social exclusion and embarrassment associated
AIDS in adolescents is mostly transmitted from with their HIV/AIDS status, adolescents often
the mother (Cluver, et al., 2015; Yi, et al., 2018). isolate themselves so as not to be hurt by others
The average age of starting ARVs is in the 8-9 (Ashaba, et al., 2019). Negative perception
year age range (Firdu, Enquselassie, & Jerene, about HIV/AIDS is a chronic disease caused
2017; Xu, et al., 2017). Three studies stated that by unsafe sexual activity (Kariuki, Some, &
adolescents had received ARVs for an average of Kimanthi, 2016) and people with HIV/AIDS
6-8.4 years (Firdu, Enquselassie, & Jerene, 2017; will experience premature death and poor
Okawa, et al., 2018; Yi, et al., 2018). Three studies health (Ashaba, et al., 2019). This is in line
suggest that most adolescents are on first-line with research which states that feelings of
ARV regimens (Firdu, Enquselassie, & Jerene, anxiety occur in people with HIV because there
2017; Xu, Munir, Kanabkaew, & Le Coeur, is a perception that people with HIV will die
2017; Yi, et al., 2018). According to a study in sooner. This is a source of stress and depression
Cambodia 76.8% of adolescents experienced a (Sosodoro, Ahmad, Prabandari, & Hakimi,
decrease in viral load after antiretroviral therapy 2017).
(Yi, et al., 2018). Adolescents who adhere to Discrimination causes adolescents with
ARV treatment in Thailand are 51.6%(Xu, HIV/AIDS to believe that they are inferior to
Munir, Kanabkaew, & Le Coeur, 2017). While their peers and are shunned by their peers at
research in Ethiopia, adolescent compliance is school and the act of social exclusion causes
79.1%(Firdu, Enquselassie, & Jerene, 2017). feelings of shame and anger and even thoughts
The problem with adolescents with HIV is of suicide (Ashaba, et al., 2019). Research
knowledge about their own HIV status (Beima- in Zambia states that there is a relationship
Sofie, et al., 2017). Most adolescents (50.7%) between high scores of depressive symptoms
never disclosed their HIV status to anyone (Yi, and unsatisfactory relationships with families
et al., 2018). The majority of caregivers 68.42% and health workers and adolescents of whom
said disclosure requires attention to the stage of experience the stigma (Okawa, et al., 2018).
development and maturity. The unpreparedness Poverty is a challenge for adolescents with HIV
of caregivers, lack of knowledge and skills to where parents with HIV cannot work because
disclose the status of their children are obstacles of HIV / AIDS so that adolescents feel they are
in. Lack of disclosure, delay in disclosing in poor conditions with basic needs that are
treatment is a challenge for adolescents with not met, do not receive education and children
HIV (Kariuki, Some, & Kimanthi, 2016). are encouraged to work informally to fulfill
Adolescents have felt depressed due to the their needs (Ashaba, et al., 2019). The financial
stigma of HIV on themselves and their families pressure that occurs is a significant burden

312
Nuraidah, et all. / Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

in the lives of children with HIV. Insufficient by the child and his family. (DeSilva, et al.,
household funds and long-term financial 2018). Disclosure is very important to facilitate
uncertainty negatively impact the ability to discussion between parents, youth and health
control and take ART, leading to barriers to workers about the disease and its treatment as
medication adherence (Ramaiya, et al., 2016). well as facilitate access to peer support groups
Good knowledge about HIV / AIDS and (Cluver, et al., 2015). The benefits of disclosure
ARV treatment, including the consequences are that it makes it easier to find support, relieve
and resistance due to suboptimal adherence the emotional burden of secrets, and educate
can encourage adolescents to adhere to ARV their children about the dangers of HIV
treatment (Xu, et al., 2017). Adolescent (Nalugya, et al., 2018). Several caregivers shared
knowledge about HIV status can improve experiences with adolescents who were not told
adherence (Cluver, et al., 2015). Adolescents they were born with HIV, complicating efforts
must have the ability to disclose their HIV to emphasize the importance of adherence to
status to others and face discrimination and ART (Maccarthy, et al., 2018), so that there is a
seek help in a timely manner (Xu, et al., significant relationship between HIV disclosure
2017). Adolescents feel they have values and and adherence to ARVs and there is an increase
self-worth when they become leaders in peer in ARV compliance after disclosur. (Montalto,
support groups (Xu, et al., 2017). Transition et al., 2017).
is from childhood to adolescence (Kariuki, Basically, adherence to HIV treatment
Some, & Kimanthi, 2016) and participation in is almost the same as adherence to pulmonary
worship helps youth with HIV improve their TB treatment, namely, taking medication on
ability to cope with the challenges of living time and not being interrupted. Drug taking
with HIV (Ashaba, et al., 2019). In addition, supervisors to support medication adherence
beliefs that make people survive, internalized in patients with pulmonary TB is an important
character of survival abilities and pleasant component (Fadila & Riono, Pandu, 2014), as
social behavior support compliance (Woollett, well as in supporting ARV treatment adherence
et al., 2016). Religion and beliefs, whether in HIV patients. Family support greatly
places of worship, religious leaders or through influences ARV adherence in adolescents
prayer practices are another identified type of (Kariuki, Some, & Kimanthi, 2016) including
emotional suppor. (Lypen, et al., 2015). Based emotional support and facility support related
on research results (Vyas, et al., (2014), patients to taking medication. Emotional support
who maintain personal autonomy but always and role models from caregivers can increase
maintain their relationship with God in the adolescents’ expectations about the future and
sense of surrendering to God to overcome reduce self-hatred which ultimately supports
their illness will be more compliant with their medication adherence (Ashaba, et al., 2019).
treatment regimen Adolescents who have parents or caregivers
The process of disclosure to adolescents who are more economically secure have a
living with HIV is not fully understood higher chance of compliance (Bermudez, et al.,
(DeSilva, et al., 2018). Parents generally do 2016).
not know how or when to disclose their Providing continuous information in
status to their children (Nalugya, et al., 2018). addition to strong support from health workers
Uncoordinated disclosure of HIV status during and parents or guardians can increase adherence
childhood is a major source of confusion and among adolescents and become an intervention
negative feelings about treatment (Xu, Met to reduce patient forgetting to take medication
al., 2017). A small number of caregivers have (Ankrah, et al., 2016). Patient satisfaction with
informed their child’s HIV status. The rest of the health services and adherence to ARVs can be
caregivers plan to disclose when the children influenced by health facility factors and service
are 14 years old or older. Caregivers are worried provider factors (Leon, Koosed, Philibert,
that if their child’s HIV status is revealed, the Raposo, & Benzaken, 2019). One of the health
child will be angry and hate himself and worry services provided is ARV counseling, before
about the negative stigma that will be received starting drugs and after starting ARV drugs

313
 KEMAS 17 (3) (2022) 306-318

affects adherence to ARV (Kariuki, Some, & Cambodia found that barriers to achieving
Kimanthi, 2016). Routine counseling and the ARV compliance include finding it difficult
duration of routine counseling are based on to remember taking medication (23.8%),
individual needs and are carried out face-to- adolescents will stop taking medication when
face either individually or in groups (Mark, they feel their health condition is getting worse
et al., 2017). Counseling services for those (11.0%) (Chhim, et al., 2018).
who experience stigma are very useful for Adolescents who have lost one or both
adolescents in addition to receiving counseling parents cause them to lose someone who fulfills
services in the context of HIV care (Ashaba, et their needs (Ashaba, et al., 2019; Nalugya,
al., 2019). In addition, the role of health workers Russell, Steven, Zalwango, Flavia, & Seeley,
is very influential because officers often interact Janet, 2018). Study (Okawa, et al., 2018), states
so that they have a better understanding of that adherence to ARVs is closely related to
the physical and psychological conditions of the loss of a mother; the absence of parents
patients with HIV (Isni, 2016). The peer group causes adolescents to change caregivers. Poor
is the main source of psychosocial support. relationship or communication with caregivers
Peer group activities are often described by can potentially lead to suboptimal compliance
teenagers as fun, relaxing, and open-minded (Galea, et al., 2018), and the attitude of caregivers
(Xu, et al, 2017), be an opportunity to make such as reminding when to take ARV drugs is
friends, encourage colleagues and help each done excessively (Xu, et al., 2017). Based on
other to remind each other to take medication research (Kimera, et al., 2020) adolescents
and share experiences of being HIV sufferers with one parent and adolescents living with
and undergoing ARV therapy (Kariuki, Some, caregivers also reported neglect, mistreatment,
& Kimanthi, 2016). Counseling is needed to and abuse. Many situations in which they are
promote good adherence and to reduce the risk treated as inferior to other children in the home
of HIV transmission (Ammon, Mason, S., & are usually carried out by stepmothers who
Corkery, J. M., 2018). belittle and abuse them.
Side effects after taking ARVs such If the health services provided are slow,
as feeling drunk, drowsy, insomnia, nausea, such as the old public insurance management
vomiting and stomach burning make (Galea, et al., 2018), longer travel time to clinic
adolescents lazy to take ARVs and lack of (Cluver, et al., 2015), difficulties in accessing
understanding of the indications for ARV medicines and health care including supply of
treatment also contribute to barriers to medicines, unfriendly health care providers
adherence, such as missed doses of ARVs and lack of information about diseases can
combined into a single dose (Galea, et al., cause delays in ARV adherence (Kariuki, Some,
2018). In addition, adolescents with HIV/AIDS & Kimanthi, 2016). In addition, individuals
experience instability in the family, severe who missed doses of medication cited problems
comorbidities, death of biological parents, finding transportation money to get to health
changes in primary caregivers, substance services as the main reason for not being able to
abuse and domestic violence, family financial maintain the regimen. They can’t afford to travel
difficulties(Xu, et al., 2017) and conditions of to the clinic before their medicine supplies run
emotional instability also occur in adolescents. out (Ssewamala, et al., 2019).
This complicates parents’ ability to ensure their Adherence to ARV treatment is achieved
child’s medication adherence (Galea, et al., if the ARV taken reaches 95% of the total
2018). Spiritual beliefs such as belief in healing drug given every month and can maintain its
after being prayed for by religious leaders cause achievement (Elyanu, et al., 2015; Kim, Gerver,
caregivers or parents to stop ARV treatment Fidler, & Ward, 2014). The two most common
(Kariuki, Some, & Kimanthi, 2016), and extra- approaches to ensuring adherence in clinical
curricular activities or busy school schedules settings are patient self-report and farm self-
are the most common reasons teenagers and report and pharmacy-based metrics (Kabore,
caregivers give for skipping ARV therapy. Muntner, Paul, Chamot, Eric, Zinski, Anne,
(Xu, et al., 2017). The results of the study in Burkholder, Greer, & Mugavero, Michael J.,

314
Nuraidah, et all. / Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

2015). From the article, it was written that become more afraid of HIV-related stigma
the average adherence of adolescents with and discrimination than HIV disease itself
HIV who received ARV therapy had different (Gebremedhin, et al., 2017). The important
percentages such as in Thailand (51.6%) and thing that must be grown in adolescents with
in Ethiopia (79.1%). This figure is still far HIV in order to face stigma and discrimination
below the UNAIDS target of 90% compliance. is positive self-efficacy. The results showed that
(UNAIDS, 2017). positive self-efficacy could mediate the effects
Seven articles that discuss the challenges of depression and stigma on ARV adherence
that often occur in adolescents with HIV are (Umar, et al., 2019).
disclosure status, where parents or caregivers There are several factors that support
feel this is something that is difficult to do ARV treatment adherence in adolescents,
because they are worried about the possible namely individuals, disclosure status
consequences. What is often feared due to (disclosure), family/caregivers, health care
the disclosure of HIV status in adolescents is providers including peer groups. This shows
that adolescents will be angry with caregivers how important the role and synergy between
and negative stigma from society towards individuals, families/caregivers and health
adolescents and their families. Caregivers services and peer groups is. ARV programs need
who were not biological parents experienced to involve youth and parents/caregivers in an
less difficulty in disclosing their HIV status association, especially involving psychosocial
than their biological parents. This is because and community support so as to increase
biological parents are afraid of being blamed for adolescent adherence to ARVs and encourage
transmitting HIV to their children (Medin, et adolescents to adhere to control schedules,
al., 2015). In fact, disclosure has an important thereby increasing their access to sustainable
aspect of self-management, facilitating ARV services (Graves, et al., 2018) . It is also
emotional, psychosocial and economic support better to disclose HIV status (disclosure) early
from children, other family members and on because delays in disclosing HIV status have
friends (Nalugya, et al., 2018). a negative impact on overcoming disease and
Four articles mention that stigma and medication adherence (Medin, et al., 2015). In
discrimination in adolescents with HIV are addition to the self-disclosure process, it is also
challenges in living their lives. Adolescents important to disclose status to other families.
are a group of children who are vulnerable to Patients whose status is known by their families
stigma and discrimination. Adolescents living and who receive support from their families are
with HIV are less likely to disclose their HIV four times better and have regular treatment
status to others outside the home, for fear of compared to patients who do not receive
being stigmatized (Damulira, et al., 2019) . support (Dahoklory, Romeo, & Takaeb, 2019).
Stigma can come from the closest family such as Factors that hinder adolescents’ adheren-
friends and neighbors. Stigma from the family ce to ARV therapy are individuals, caregivers/
includes discrimination and neglect (Sugiharti, families and health services. There is a difference
et al., 2019). Many individuals who experience between the factors that inhibit adherence in
stigma tend to avoid contact with other people adolescents from their parents, namely that
resulting in an inability to form friendships adolescents do not use money as an obstacle
and socialize with the surrounding community to carrying out ARV therapy (Hornschuh, et
(Anima-Korang, Gere, & Salimi, 2018). Many al., 2017). The lack of psychosocial support is
youths state that it takes a great deal of courage said to be an obstacle in adolescent compliance,
to take medicine every day at school for fear especially for those who are in boarding schools
of being identified as HIV positive and will be and manage ARV themselves (Gebremedhin,
discriminated against (Kimera, et al., 2020). et al., 2017) even though support from family
Stigma and discrimination can also lead or people around is very decisive in increasing
to missed opportunities to change victims’ the confidence of patients with HIV AIDS to
behavior to prevent transmission to others, and be able to live longer by obediently taking ARV
access HIV-related services and young people drugs (Dahoklory, Romeo, & Takaeb, 2019).

315
 KEMAS 17 (3) (2022) 306-318

2016. Equity in Adherence to Antiretroviral

Conclusion Therapy Among Economically Vulnerable
Based on the results of a literature Adolescents Living with HIV in Uganda.
AIDS Care - Psychological and Socio-Medical
study from 12 articles, it was found that
Aspects of AIDS/HIV, 28(52), pp.83-91.
ARV treatment adherence in adolescents Chhim, K., Mburu, G., Tuot, S., Sopha, R., Khol, V.,
was influenced by supporting and inhibiting Chhoun, P., & Yi, S., 2018. Factors Associated
factors. The supporting factors that influence with Viral Non-Suppression Among
compliance are individuals, disclosure status, Adolescents Living with HIV in Cambodia:
family/caregivers and health services. While A Cross-sectional Study. AIDS Research and
the inhibiting factors that affect compliance Therapy, 15(1), pp.1-10.
are individuals, families/influencers and health Cluver, L.D., Hodes, R.J., Toska, E., Kidia, K.K.,
care providers. Suggestion: it is important for Orkin, F.M., Sherrf, L., & Meincka, F., 2015.
nurses to identify the supporting and inhibiting HIV is Like A Tsotsi. ARVs are Your Guns’:
Associations between HIV-disclosure and
factors that exist in adolescents with ARV
Adherence to Antiretroviral Treatment
treatment. This will make it easier for nurses to Among Adolescents in South Africa. Aids,
identify problems that exist in adolescents so 29(1), pp.S57-S65.
that problems can be overcome together and Dahoklory, B.M., Romeo, P., & Takaeb, A.E., 2019.
do not become an obstacle in maintaining ARV The Relationship between Family Support
treatment adherence. for PLWHA and Adherence to Taking
Antiretroviral Drugs at the VCT Clinic-
References Sobat Kupang. Timorese Journal of Public
Ammon, N., Mason, S., & Corkery, J.M., 2018. Factors Health, 1(2), pp.70-78.
Impacting Antiretroviral Therapy Adherence Damulira, C., Mukasa, M.N., Byansi, W., Nabunya,
among Human Immunodeficiency Virus– P., Kivumbi, A., Namatovu, P., Namuwonge,
positive Adolescents in Sub-Saharan Africa: F., Dvalishvili, D., Bahar, O.S., & Ssewamala,
A Systematic Review. Public Health, 157(1), F.M., 2019. Examining the Relationship
pp.20-31. of Social Support and Family Cohesion
Anima-Korang, A., Gere, B.O., & Salimi, N., on ART Adherence Among HIV-positive
2018. Stigma and Discrimination: Coping Adolescents in Southern Uganda: Baseline
Strategies for Persons Living with HIV/ Findings. Vulnerable Children and Youth
AIDS in Rural America. IAFOR Journal of Studies, 14(2), pp.181-190.
Psychology & the Behavioral Sciences, 4(1), Denison, J.A., Banda, H., Dennis, A.C., Packer,
pp.1-13. C., Nyambe, N., Stalter, R.M., Mwansa,
Ankrah, D.N., Koster, E.S., Mantel-Teeuwisse, J.K., Katayamoyo, P., & McCarraher, D.R.,
A.K., Arhinful, D.K., Agyepong, I.A., & 2015. The Sky is the Limit: Adhering to
Lartey, M., 2016. Facilitators and Barriers to Antiretroviral Therapy and HIV Self-
Antiretroviral Therapy Adherence Among management from the Perspectives of
Adolescents in Ghana. Patient Preference and Adolescents Living with HIV and Their
Adherence, 10(1), pp.329-337. Adult Caregivers. Journal of the International
Ashaba, S., Cooper-Vince, C.E., Vořechovská, D., AIDS Society, 18(1), pp.1-7.
Rukundo, G.Z., Maling, S., Akena, D., & Tsai, DeSilva, M.B., Penwill, N., Sabin, L., Gifford, A.L.,
A.C., 2019. Community beliefs, HIV Stigma, Li, Z., Fujie, Z., Weiwei, M., Yongzhen, L.,
and Depression Among Adolescents Living Hongyan, L., Xuemei, Z., Barnoon, Y., Gill,
with HIV in Rural Uganda. African Journal C.J., & Bonawitz, R., 2018. We Don’t Dare to
of AIDS Research, 18(3), pp.169-180. Tell Her … We Don’t Know Where to Begin:
Beima-Sofie, K.M., Brandt, L., Hamunime, N., Disclosure Experiences and Challenges
Shepard, M., Uusiku, J., John-Stewart, G.C., & among Adolescents Living with HIV and
O’Malley, G., 2017. Pediatric HIV Disclosure Their Caregivers in China. International
Intervention Improves Knowledge and Journal of Pediatrics and Adolescent Medicine,
Clinical Outcomes in HIV-infected Children 5(1), pp.5-12.
in Namibia. Journal of Acquired Immune Elyanu, P., Nabukeera-Barungi, N., Asire, B.,
Deficiency Syndromes, 75(1), pp.18-26. Katureebe, C., Lukabwe, I., Namusoke, E.,
Bermudez, L.G., Jennings, L., Ssewamala, F.M., Musinguzi, J., Atuyambe, L., & Tumwesigye,
Nabunya, P., Mellins, C., & McKay, M., N., 2015. Adherence to Antiretroviral Therapy

316
Nuraidah, et all. / Adherence to Taking ARV Drugs in Adolescents with HIV/AIDS

and Retention in Care for Adolescents Living Isni, K., 2016. Family Support, Support from Health
with HIV from 10 Districts in Uganda. BMC Workers, and Behavior of HIV Mothers
Infectious Diseases, 15(1), pp.1-11. in Preventing HIV/AIDS Transmission to
Fadila, R.N., & Riono, P., 2014. Effect of Regimen on Babies. Journal of Public Health, 11(2), pp.96-
Non-adherence to Tuberculosis Treatment. 104.
National Journal of Public Health, 9(2), James, S.R., Nelson, K.A., & Ashwill, J.W., 2013.
pp.107-112. Nursing Care of Children: Principles &
Firdu, N., Enquselassie, F., & Jerene, D. (2017). HIV- Practice. St. Louis: Saunders, Elsevier.
infected adolescents have low adherence Kabore, L., Muntner, P., Chamot, E., Zinski, A.,
to antiretroviral therapy: A cross-sectional Burkholder, G., & Mugavero, M.J., 2015.
study in Addis Ababa, Ethiopia. Pan African Self-report Measures in the Assessment
Medical Journal, 27(80), 1-11. of Antiretroviral Medication Adherence:
Galea, J.T., Wong, M., Muñoz, M., Valle, E., Leon, Comparison with Medication Possession
S.R., Perez, D.D., Kolevic, L., & Franke, Ratio and HIV Viral Load. Journal of the
M., 2018. Barriers and Facilitators to International Association of Providers of
Antiretroviral Therapy Adherence Among AIDS Care, 14(2), pp.156-162.
Peruvian Adolescents Living with HIV: A Kariuki, T.W., Some, E.S., & Kimanthi, G., 2016.
Qualitative Study. PLoS ONE, 13(2), pp.1-19. Determinants of Antiretroviral Treatment
Gebremedhin, M., Gebrehawerya, T., Tesfaye, G., Adherence among HIV/ AIDS Infected
Gebretsadik, G., & Kebede, L., 2017. Stigma Adolescents in Thika Level 5 Hospital.
and Discrimination Towards HIV Positive International Academic Journals, 1(1), pp.1-
People Among in-school Adolescents, in 10.
Babile Town, Eastern Ethiopia: A Cross Kementrian Kesehatan RI., 2014. Guidelines for
Sectional Study. Journal of HIV and AIDS, the Application of HIV Therapy in Children.
3(3), pp.1-5. Jakarta: Kemenkes RI.
Graves, J.C., Elyanu, P., Schellack, C.J., Asire, B., Kementrian Kesehatan RI., 2018. National Standard
Prust, M.L., Prescott, M.R., Mirembe, E., Guidelines for Adolescent Care Health Services
Lukabwe, I., Mirembe, B., Musinguzi, J., & (PKPR). Jakarta: Kementrian Kesehatan RI.
Moberley, S.A., 2018. Impact of A Family Kementrian Kesehatan RI., 2019. Report on the
Clinic Day Intervention on Paediatric and Progress of HIV AIDS and PIMS in the Second
Adolescent Appointment Adherence and Quarter of 2019. Jakarta: Ditjen P2P.
Retention in Antiretroviral Therapy: A Kim, S.H., Gerver, S.M., Fidler, S., & Ward, H.,
Cluster Randomized Controlled Trial in 2014. Adherence to Antiretroviral Therapy
Uganda. PLoS ONE, 13(3), pp.1-19. in Adolescents Living with HIV: Systematic
Heestermans, T., Browne, J.L., Aitken, S.C., Vervoort, Review and Meta-analysis. AIDS, 28(13),
S.C., & Klipstein-Grobusch, K., 2016. pp.1945-1956.
Determinants of Adherence to Antiretroviral Kimera, E., Vindevogel, S., Kintu, M.J., Rubaihayo, J.,
Therapy among HIV-positive Adults in sub- De-Maeyer, J., Reynaert, D., Engelen, A.-M.,
Saharan Africa: A Systematic Review. BMJ Nuwaha, F., & Bilsen, J., 2020. Experiences
Global Health, 1(4), pp.1-14. and Perceptions of Youth Living with HIV
Holtzman, C.W., Brady, K.A., & Yehia, B.R., 2015. in Western Uganda on School Attendance:
Retention in Care and Medication Adherence: Barriers and Facilitators. BMC Public Health,
Current Challenges to Antiretroviral Therapy 20(1), pp.1-13.
Success. HHS Public Access, 1(4), pp.1-18. Leon, C., Koosed, T., Philibert, B., Raposo, C.,
Hornschuh, S., Dietrich, J.J., Tshabalala, C., & & Benzaken, A.S., 2019. HIV/AIDS
Laher, F., 2017. Antiretroviral Treatment Health Services in Manaus, Brazil: Patient
Adherence: Knowledge and Experiences Perception of Quality and Its Influence on
Among Adolescents and Young Adults in Adherence to Antiretroviral Treatmen. BMC
Soweto, South Africa. AIDS Research and Health Services Research, 19(1), pp.1-11.
Treatment, 2017(1), pp.1-9. Lypen, K.D., Lockwood, N., Shalabi, F., Harper,
Hudelson, C., & Cluver, L., 2015. Factors Associated G.W., & Ngugi, E., 2015. When We are
with Adherence to Antiretroviral Therapy Together I Feel at Home. Types and Sources
Among Adolescents Living with HIV / AIDS of Social Support Among Youth Newly
in Low- and Middle-income Countries : Diagnosed with HIV in Kenya: Implications
A Systematic Review. AIDS Care, 27(7), for Intervention. African Journal of AIDS
pp.805-816. Research, 14(3), pp.275-284.

317
 KEMAS 17 (3) (2022) 306-318

Maccarthy, S., Saya, U., Samba, C., Birungi, J., Infected Housewife: A Phenomenological
Okoboi, S., & Linnemayr, S., 2018. How am Study. Journal of Public Health, 13(2), pp.158-
I Going to Live ?: Exploring Barriers to ART 168.
Adherence among Adolescents and Young Ssewamala, F. M., Byansi, W., Bahar, O.S., Nabunya,
Adults Living with HIV in Uganda. BMC P., Neilands, T.B., Mellins, C., McKay, M.,
Public Health, 18(1158), pp.1-11. Namuwonge, F., Mukasa, M., Makumbi, F.E.,
Mark, D., Armstrong, A., Andrade, C., Penazzato, & Nakigozi., 2019. Suubi+Adherence Study
M., Hatane, L., Taing, L., Runciman, T., Protocol: A Family Economic Empowerment
& Ferguson, J., 2017. HIV Treatment and Intervention Addressing HIV Treatment
Care Services for Adolescents: A Situational Adherence for Perinatally Infected
Analysis of 218 Facilities in 23 Sub- Adolescents. Contemporary Clinical Trials
Saharan African Countries. Journal of the Communications, 16(100463), pp.2451-8654.
International AIDS Society, 20(3), pp.25-33. Sugiharti, H.R.S., Lestary, H., Mujiati., & Susyanti,
Medin, G., García-Navarro, C., Navarro, G.M., A.L., 2019. Stigma and Discrimination
Ramos, A.J.T., Mellado, M J., Jimenez, Against Children with HIV AIDS (ADHA)
S., 2015. Disease Disclosure, Treatment in Ten Districts/Cities in Indonesia. Journal
Adherence, and Behavioural Profile in a of Reproductive Health, 10(2), pp.153-161.
Cohort of Vertically Acquired HIV-infected Umar, E., Levy, J.A., Donenberg, G., Mackesy-
Adolescents. NeuroCoRISpeS study. AIDS Amiti, M.E., Pujasari, H., & Bailey, R.C.,
Care, 28(1), pp.1-7. 2019. The Influence of Self-efficacy on the
Montalto, G.J., Sawe, F.K., Miruka, A., Maswai, J., Relationship Between Depression and HIV-
Kiptoo, I., Aoko, A., Oreyo, C., Obiero, E., Related stigma with ART Adherence among
Korir, S., Bii, S.K., Song, K.X., & Kunz, A.N., the Youth in Malawi. Jurnal Keperawatan
2017. Diagnosis Disclosure to Adolescents Indonesia, 22(2), pp.147–160.
Living with HIV in Rural Kenya Improves UNAIDS., 2017. UNAIDS Data 2017. Switzerland:
Antiretroviral Therapy Adherence and UNAIDS.
Immunologic Outcomes: A Retrospective UNAIDS. 2018. UNAIDS Data 2018. Switzerland:
Cohort Study. PLoS ONE, 12(10), pp.1-11. UNAIDS.
Nalugya, R., Russell, S., Zalwango, F., & Seeley, Vyas, K.J., Limneos, J., Qin, H., & Mathews, W.C.,
J., 2018. The Role of Children in Their 2014. Assessing Baseline Religious Practices
HIV-positive Parents’ Management of and Beliefs to Predict Adherence to Highly
Antiretroviral Therapy in Uganda. African Active Antiretroviral Therapy among HIV-
Journal of AIDS Research, 17(1), pp.37-46. infected Persons. AIDS Care - Psychological
Okawa, S., Mwanza, K.S., Mwiya, M., Kikuchi, K., and Socio-Medical Aspects of AIDS/HIV,
Jimba, M., Kankasa, C., & Ishikawa, N., 2018. 26(8), pp.983-987.
Psychological Well-being and Adherence to Woollett, N., Cluver, L., M.Hatcher, A., &
Antiretroviral Therapy among Adolescents Brahmbhatt, H., 2016. To be HIV Positive
Living with HIV in Zambia. AIDS Care - is not the End of the World: Resilience
Psychological and Socio-Medical Aspects of among Perinatally Infected HIV Positive
AIDS/HIV, 30(5), pp.634-642. Adolescents in Johannesburg. Children and
Ramaiya, M.K., Sullivan, K.A., O’Donnell, K., Youth Services Review, 70(C), pp.269-275.
Cunningham, C.K., Shayo, A.M., Mmbaga, Xu, L., Munir, K., Kanabkaew, C., & Le-Coeur, S.,
B.T., & Dow, D.E., 2016. A Qualitative 2017. Factors Influencing Antiretroviral
Exploration of the Mental Health and Treatment Suboptimal Adherence Among
Psychosocial Contexts of HIV-positive Perinatally HIV Infected Adolescents in
Adolescents in Tanzania. PLoS ONE, 11(11), Thailand. PLoS ONE, 12(2), pp.1-18.
pp.1-13. Yi, S., Tuot, S., Pal, K., Khol, V., Sok, S., Chhoun,
Shaluhiyah, Z., Suryoputro, A., & Setyawati, A., P., Ferguson, L., & Mburu, G., 2018.
2017. The Need of Information Services Characteristics of Adolescents Living
on Reproductive Health, STIs And HIV in with HIV Receiving Care and Treatment
Middle Adolescent. Journal of Public Health, Services in Antiretroviral Therapy Clinics
12(2), pp.96-105. in Cambodia: Descriptive Findings from A
Sosodoro, O., Ahmad, R.A., Prabandari, Y.S., & Cross-sectional Study. BMC Health Services
Hakimi, M., 2017. Internal Stigma of An Hiv Research, 18(1), pp.1-13.

318