Barriers to antiretroviral therapy adherence among young people living with HIV/AIDS in selected hospitals in Imo State, Nigeria

Young people in sub-Saharan Africa (SSA) bear a disproportionate burden of global HIV. Young people living with HIV/AIDS (YPLWHA) experience poorer treatment outcomes compared to adults. This study assessed the barriers that affect antiretroviral therapy (ART) adherence among YPLWHA. This cross-sectional comparative survey involved 146 participants from Imo State Specialist Hospital (ISSH), Umuguma, and 66 participants from Imo State Teaching Hospital (IMSUTH), Orlu, both in Imo State, Nigeria. Participants were aged 10–24 years and had been receiving ART for at least one year. An adapted questionnaire was used to assess barriers to ART adherence, including psychosocial and health system/service delivery factors. Adherence was evaluated by participants’ self-reported missed doses in the preceding three months, hospital refill records, and pill counts. Logistic regression and a 4-point Likert scale were employed to identify factors independently associated with ART adherence at a significance threshold of p = 0.05. The overall medication adherence rates were 75.8% for IMSUTH and 87.7% for ISSH. YPLWHA at the IMSUTH facility had significantly lower odds of adhering to their medication compared to those at the ISSH (AOR = 0.44, 95% CI [0.21, 0.93]). Forgetfulness and medication side effects were the most frequently cited reasons for missed doses in both hospitals. Socio-demographic analysis revealed that place of residence and proximity to the healthcare facility were significant factors associated with ART adherence at both IMSUTH and ISSH. Participants residing farther from the hospital at both facilities demonstrated significantly higher odds of adherence compared to those living nearby, with adjusted odds ratios of 6.55 at IMSUTH and 10.8 at ISSH. Furthermore, age was a significant factor at ISSH, with participants aged 10–14 exhibiting higher adherence rates (AOR = 0.09, 95% CI: 0.01–0.95). Additional barriers identified using the Likert scale included long waiting times at the clinic and insufficient transportation funds. Medication adherence among YPLWHA in Imo State, Nigeria, remains suboptimal. This may impede the achievement of UNAIDS’s third 95 target, which aims for 95% of individuals on ART to achieve viral suppression by 2030. Targeted interventions for this age group are warranted. Establishing dedicated clinics for YPLWHA could reduce waiting times and help prevent disruptions to their academic activities. Integrating mobile health (mHealth) solutions into their care regimen may decrease the frequency of hospital visits and associated transportation costs.