Background More than eight in ten of the world’s 1.65 million adolescents living with HIV live in sub-Saharan Africa. Despite the availability of antiretroviral therapy (ART), there is limited robust data on adherence to ART levels among adolescents, as this group is often neglected in HIV research.

Objective

Our study aimed to estimate and compare adherence levels, based on self-reporting, pharmacy-refill counts and electronic monitoring using a digital adherence tool (DAT) among adolescents living with HIV in Tanzania.

Methods We used three measures to assess adherence levels among adolescents aged 15 to 19 years, residing in Kilimanjaro region, in Tanzania. Median adherence levels were calculated, and optimal adherence was defined as > 95% of pills taken. Adolescents used the DAT, the Wisepill dispenser (RT2000), for one month and were followed-up with a short semi-structured exit-interview. Thereafter, adolescents were interviewed about their experiences with using the Wisepill® device.

Results Median adherence levels were respectively 100% (IQR 93 – 100%), 97% (IQR 85 – 98%) and 72% (IQR 24 – 91%), based on self-report, pharmacy-refill counts and on results from the DAT. Strikingly, out of the twenty participants, the proportion of adolescents achieving 95% pill intake were 70%, 55% and 20% of adolescents respectively.

Conclusion Even based on self-reported adherence, only less than three-quarters of adolescents achieved sufficient adherence to treatment. Therefore, interventions to improve adherence to ART regimen are urgently needed among HIV-positive adolescents, especially in resource-limited settings.