Factors Affecting Adherence to Antiretroviral Therapy Among HIV-Positive Children in Kebbi State, North West Nigeria

Optimal adherence to antiretroviral therapy (ART) is essential for viral suppression, immune recovery, and prevention of drug resistance among HIV-positive children. Despite increased ART access, adherence remains challenging in resource-limited settings. This cross-sectional analytical study investigates factors affecting ART adherence among HIV-positive children aged 1 to 14 years receiving care at the paediatric HIV clinic of the General Hospital Birnin Kebbi, Kebbi State, North West Nigeria. Caregivers of 175 HIV-positive children on ART for at least six months were interviewed using a structured questionnaire. ART adherence was measured using caregiver report, pharmacy refill records, and pill count methods, with optimal adherence defined as intake of at least 95% of prescribed doses. Optimal adherence was reported in 61.7% of children. Significant predictors of suboptimal adherence included caregiver non-disclosure of HIV status to the child, caregiver burden of care responsibilities, drug palatability complaints, and frequent stock-outs of paediatric ART formulations. Caregiver knowledge of ART mechanisms was positively associated with adherence (OR 2.8). Forgetfulness was cited as the most common reason for missed doses by 58.3% of caregivers. The study recommends structured adherence counselling, simplified dosing schedules, community-based treatment support, and psychosocial support for caregivers managing HIV-positive children. Keywords: ART adherence, paediatric HIV, Kebbi State, caregivers, North West Nigeria.