There are several antiretroviral (ARV) drug combinations available for the therapy of HIV infection, but adherence to the prescribed treatment is crucial for good therapeutic outcomes. Poor adherence can have dire health repercussions for patients, including failure to achieve viral suppression and development of drug resistance, which can render some antiretroviral drugs permanently ineffective. Hence, the use of combination antiretroviral medication is crucial in the efficient management of HIV. The complexity of the treatment regimens may, however, pose additional hurdles to adherence. Such challenges are especially severe for children, adolescents and people who depend on carers for health care support. Adolescence is a period of fast physical; psychological and physiological development and these changes may present particular difficulties for commitment to therapy. Therefore, monitoring adherence to ART among orphans and vulnerable children living with HIV is critical to identify barriers to adherence and create suitable treatments to enhance health outcomes.

Methodology: The study was carried out in Rivers west senatorial district of Rivers State among children and adolescent between 0-17 years. This cross sectional descriptive was used to explore the treatment adherence among the population of study with a total sample size of 340 participants. A structured self-administered questionnaire was used to elicit response from the respondents and this quantitative data was analyzed using SPSS to determine the treatment plan.

Result: It is evident that individuals with high viral load made most of the study sample accounting for hundred and fourth respondents. Among the lower viral load, adherence was at 57.14% and non-adherence was 42.7% and low viral load group, adherence was 69.6% and non-adherence was 30.4%. A chi-square test of independence shows that there was no significant association between viral load and adherence X² (1, N = 165) p = .262.  The p value is greater than the significant value thus, it is accepted that there is no statistically significant relationship between viral load of the children infected with HIV/AIDS and adherence. It also shows that there is a statistically significant association between age and adherence to medication. Participants in the age range of 0-9years were more adherent to medications compared with those between 10-17 years (100% vs 44.1%; p=0. 0001). Also, the table revealed that the respondents who are young were 2.268 times more likely to adhere to medications than who older participants (OR: 2.268; CI = 1.975-2.605).

Conclusion: The study has highlighted specifically that orphan and vulnerable children in Rivers West senatorial district has very good adherence as the mean adherence for the study was 92%. It is advice that it should be maintained since high adherence rate relates positively with viral load when the CD4 has not reached 500 cell/mm3 knowing very well that low viral load reduces risk of infections, as majority of guidance/caregivers strictly adhered to treatment therapy, and it is believed that they have basic knowledge of treatment plan for HIV.