Pediatric Adherence to HIV Antiretroviral Therapy

Massachusetts General Hospital Center for Global Health, Harvard Initiative for Global Health, 3rd floor, Cambridge, MA 02138, USA.
Current HIV/AIDS Reports (Impact Factor: 3.8). 11/2009; 6(4):194-200. DOI: 10.1007/s11904-009-0026-8
Source: PubMed


More than 2 million children are infected with HIV globally. Pediatric antiretroviral therapy (ART) adherence is complex, and current levels are often suboptimal. As established treatment programs in developed settings struggle with chronic therapy and nascent treatment programs in resource-limited settings expand, the importance and challenges of good adherence to ART are becoming ever more clear. Adherence behavior is influenced by many factors, which may be categorized as characteristics of the child, the caregiver(s) and family, the regimen, and society and culture. Many of these influences complicate measurement of pediatric adherence, and there is no gold standard. This article provides a conceptual framework and evidence-based look at the factors influencing ART adherence in children and aims to identify areas for intervention for this vulnerable population in need.

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Available from: Claude Mellins, Dec 10, 2014
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    • "This result was in agreement with another study, where there was no a significant association between religion of the caregivers and adherence [11]. A child’s adherence to ART is strongly influenced by the caregiver and the successful treatment of a child requires the commitment and involvement of a responsible caregiver [3,8]. In this study, biologic caregivers were not associated with better adherence. "
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    ABSTRACT: Adherence to antiretroviral therapy (ART) in children is complicated may be because of many factors such as child characteristics, caregiver and family characteristics, regimen characteristics, etc. Therefore, it is important to identify factors associated with adherence in HIV infected children in order to reduce the risk of developing treatment failure or drug resistance through interventions. This survey was planned to find out the rate of adherence to ART and its associated factors among the children in Mekelle, Tigray region, Ethiopia. A cross-sectional survey was conducted in two hospitals in Mekelle: Ayder Referral Hospital and Mekelle Hospital, during the months of February to March 2013. A structured questionnaire was administered to caregivers to assess patient's adherence. Out of a total of 193 patients, 83.4% as reported by caregivers were adherent to ART in the past seven days before the interview. On multivariate logistic regression model, it was found that the children whose caregivers were unmarried (AOR = 15.17, 95% CI: 3.36-68.43) and married (AOR = 3.54, 95% CI: 1.23-10.13) were more likely to adhere to their ART treatment than those whose caregivers were divorced/separated. Similarly, children whose caregivers' age groups of 25-34 (AOR = 22.27, 95% CI: 4.34-114.29) and 35-44 (AOR = 7.14, 95% CI: 1.65-30.95) were more likely to adhere than their counterparts. The major reasons reported by caregivers for missing medicines include: child being depressed (24.4%), drug side effects (16.3%), too many pills (15.5%) and difficulty in swallowing pills (13.3%). The prevalence of adherence to ART among children was found to be high and comparable to that of other similar setups. Nevertheless, encouraging the fundamental role of caregivers is so significant to improve adherence among those who missed a dose or more and consequently treatment outcomes of children with HIV.
    Full-text · Article · Apr 2014 · BMC Pediatrics
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    • "Adherence is a serious challenge for those receiving ART especially children. Factors associated with paediatric ART adherence can be related to caregivers, children themselves, the medication/regimen, socioeconomic, or service delivery issues [11-14]. "
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    ABSTRACT: Poor adherence to antiretroviral therapy negatively affects the suppression of viral replication. It increases risks of drug resistance, treatment failure, Acquired Immuno Deficiency Syndrome (AIDS)-related morbidity and mortality among children. This study assessed the level of adherence to antiretroviral therapy and its associated factors among children at hospitals in South Wollo Zone, Northeast Ethiopia. An institution-based cross-sectional study was conducted among Human Immunodeficiency Virus (HIV)-infected children in April 2013. A total of 464 children who were taking Antiretroviral Therapy (ART) in the hospitals were included. Data were collected using pretested and structured questionnaires using a face-to-face interview method. Descriptive and summary statistics were employed. Bivariate and multiple logistic regressions were computed. Odds ratios and their 95% confidence intervals were computed to determine the level of significance. Of the 464 study samples, 440 children with their caregivers were included in the final analysis. A total of 78.6% of the caregivers reported that their children were adherent to antiretroviral therapy in the month prior to the interview. Caregivers' knowledge about antiretroviral treatment [AOR = 2.72(95%CI: 1.82, 5.39)], no current substance use of the caregivers [Adjusted Odds Ratio (AOR) = 2.21(95% Confidence Interval (CI): 1.34, 7.13)], proximity to the health care facility [AOR = 2.31(95%CI: 1.94, 4.63)], if the child knows HIV-positive status[AOR = 3.47(95%CI: 2.10, 6.81)] and caregiver's educational status [AOR = 0.59(95%CI: 0.21, 0.82)] were significantly and independently associated with adherence of children to antiretroviral therapy. Adherence of antiretroviral therapy in this study was comparable to other studies conducted in developing countries. Caregiver's knowledge about antiretroviral therapy, no current use of substances, close proximity to health facilities, and letting child's know his/her HIV status improves adherence to antiretroviral therapy. Health care providers should educate caregivers about antiretroviral therapy and encourage HIV positive status disclosure to the child.
    Full-text · Article · Apr 2014 · BMC Public Health
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    • "With introduction and successful use of Highly Active Antiretroviral Therapy (HAART),HIV-infected children are surviving into adolescence and facing many adherence challenges associated with long-term therapy [5]. Poor adherence increases the risk of virologic failure and viral resistance, therefore, optimal adherence (> 95% of pills taken) is the key to success in HIV infected children who are onlong term treatment [4]. "
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    ABSTRACT: Introduction Paediatric adherence to Highly Active Antiretroviral Therapy (HAART) is a dynamic process involving many factors. Adherence for the majority on therapy matters to prevent failure of 1st and 2st line therapy. The purpose of this study was to determine the rate of adherence to antiretroviral therapy in HIV infected children. Methods We conducted a cross-sectional hospital based analytical study, from October 2011 to April 2012. HIV-infected children aged 2 to 17 years who had been on treatment for at least six months were enrolled. Data were collected by a standard questionnaire. Two-day self-report, one month self-recall report, and pill count were used to assess adherence. Results One hundred and eighty three respondents participated in this research. There were 92 (51%) males and 91 (49%) females. Only 45 (24.6%) had good adherence to their drug regimen when subjected to all three methods of assessment. Males were more adherent to ART than females (OR= 2.26, CI 1.05-4.87, p = 0.04). Adherence was worse among children who developed ART side effects (OR= 0.19, CI 0.07- 0.56;p = 0.01), could not attend clinic on regular basis (OR= 3.4, CI 1.60- 7.36, p = 0.01) and missed drug doses in the six months period prior to interview (OR= 0.40, CI 0.18-0.82, p= 0.01). Conclusion Only 24.6% of paediatric patients had good adherence to ART when subjected to all three measures. Drug side-effects, missing drug doses in the six months period prior to study start, monthly income and affording transportation to the clinicwere strong predictors of adherence.
    Full-text · Article · Mar 2014 · Pan African Medical Journal
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