Factors influencing adherence to anti-retroviral treatment in children with human immunodeficiency virus in South India – a qualitative study (original) (raw)
Related papers
2015
Background: The success of antiretroviral therapy (ART) depends on a high level of adherence to a lifelong regimen of antiretroviral drugs (ARVs). Adherence is a concern in children because of factors relating to children such as age, disclosure status of HIV sero-status, and understanding of the medication. Few studies have determined the level of adherence of ART among children since the scale-up of access to ARVs in the study areas. This study was thus undertaken to determine the level of ART adherence among pediatric pat ients at an ART clinic, the reasons for non-adherence, and the factors associated with adherence, according to mothers/caregivers' reports. Methods: Hospital based cross-sectional descriptive study design combining quantitative and qualitative methods was used. Three hundred thirteen HIV-positive children attending the ART center of referral hospitals were recruited in this study. The study was conducted from January-February 2013. An interviewer administered questionnaire was used to collect data. Data were entered in the Epi info software version 3.5.1 and then exported to the SPSS version 16 for quantitative analysis. Results: Adherence to ART in 313 HIV positive children during the past three and seven days was assessed, and 310 (99%) and 304 (97%) of them took greater than 95% of the total prescribed doses, respectively. According to the care givers' report, the average rate of adherence to ART among children was 284 (90.7%) in the one month recall period prior to the study. Disclosure of the child's sero status to the child, age of the child, occupational status, caregiver's relationship with child, and caregiver's knowledge of ARV treatment were factors independently associated with adherence to ART. Conclusion: The current study showed that the level of adherence to antiretroviral therapy was found to be high. Health care providers should reinforce adherence counseling during follow up and address proper usage of medication reminders. Further study on adherence rate and its determinants with multiple adherence measurements to determine the barriers to adherence is also recommended. [3]. The goals of ARV therapy for children are to increase survival, improve quality of life and decrease HIV-related morbidity and mortality [4]. For ART to work effectively, adherence is very crucial. The recommended optimal adherence level for ART to be effective is above 95 percent [5]. Any patient who misses more than 3 dosages in a one month treatment course is considered to have achieved suboptimal adherence which is less than 95% [6]. A level of adherence which is greater than 95% (optimal adherence) suppresses viral replication and prevents the development of resistance and treatment failure. Thus, there is evidence that failure to adhere to the prescribed treatment regimen is associated with adverse clinical outcomes. Then, efforts to improve adherence rates are likely to result in improved health outcomes.
Bulletin of the National Research Centre
Background Successful response to treatment of HIV infection is largely determined by adherence to antiretroviral therapy (ART) and manifests as an improvement in CD4 counts. Certain challenges to attaining high rates of adherence are specific to the paediatric population since children are dependent on a caregiver and are not often disclosed with the status of being infected. Analysing the factors affecting adherence, monitoring the side effects related to therapy and the progress of CD4 counts will help identify challenges to treatment and improve quality of life in these children. Results 89.6% of children (n = 86) showed optimal adherence to ART. The relationship of the caregiver to the child (biological parents) and the rise in CD4 count were the only factors found to be significantly associated with adherence to ART. The most reported side effect following ART was a skin rash, associated with the use of Nevirapine. Conclusions Adherence to ART in the paediatric age group can b...
HIV/AIDS - Research and Palliative Care, 2020
This study explored the caregivers' self-reported determinants of antiretroviral therapy (ART) adherence among children under five years living with human immunodeficiency virus (HIV) infection attending Al-Sabah Hospital, South Sudan. Methods: A cross-sectional study of 126 caregivers of HIV-infected children under five years was conducted at Al-Sabah Hospital, South Sudan. Data were collected using an intervieweradministered questionnaire. The self-reported adherence was measured as a binary variable using binary logistic regression. Only variables that were significant at bivariate analysis were analyzed at multivariate level and interpreted using the odds ratios (p< 0.05). Results: Out of 126 caregivers with HIV-infected children, 38 (30.2%) did not adhere to ART. Of the proportion that adhered to ART (88, 69.8%), 49 (55.7%) were male. Most of the children (52, 59.1%) were above two years, but under five years. Fifty (56.8%) of those who adhered had completed 3 months on ART, and the majority were at WHO stage-1 of HIV infection. Analysis of the determinants indicated that children's duration on ART (p=0.001), type of ART regimen (single, double or triple therapy) (p=0.065), type of work done by the caregiver to earn a living (p-value 0.003), time a child was initiated on ART (p=0.002), caregiver-child relationship (p=0.002), caregiver-spousal support (p=0.019), type of support obtained whether monetary or not (p=0.000), when the child was started on ART (p=0.004), the person administering ART (p=0.010), the type of ARVs administered (p=0.001), the caregiver detecting ART side effects (p=0.000), types of adverse effects suffered by the child (p=0.043), time of receiving ART (p=0.047), use of western medicine (p=0.043), healthcare cadre (p=0.002), the kind of attention the healthcare provider offered (p=0.015), and improvements in quality of HIV services (p=0.001) were significantly associated with ART adherence. Conclusion: The study findings indicated that ART adherence among HIV-infected children under five years was suboptimal. This will necessitate continuous engagement and education of caregivers on the prominence of adhering to ART.
The success of antiretroviral therapy (ART) depends on a high level of adherence to a life-long regimen of antiretroviral drugs (ARVs). Adherence is a concern in children because of factors relating to children such as age, disclosure status of HIV sero-status, and understanding of the medication. Few studies have determined the level of adherence of ART among children since the scale-up of access to ARVs in the study areas. This study was thus undertaken to determine the level of ART adherence among pediatric pat ients at an ART clinic, the reasons for non-adherence, and the factors associated with adherence, according to mothers/caregivers' reports.
African Journal of Health Sciences, 2013
Background: Ensuring high level of adherence to anti-retroviral medication (ARV) is a priority in treating people living with HIV and AIDS. Adherence in children cannot be fully studied if we do not recognize the involvement of primary caregivers who largely determine how well and often the ARV medication is taken. Objective: To determine attitude and practices of the primary caregivers on adherence of ARV in HIV+ve children. Methods: A cross-sectional study involving primary caregivers of HIV +ve children. Interviewer administered questionnaires were used to collect data from 126 primary caregivers. The data was complemented with key informant in-depth interviews with the health workers at the Comprehensive Care Centre (CCC) and two focus group discussions (FGD) of the primary caregivers. Setting: Kenyatta National Hospital comprehensive care centre for HIV/AIDS. Results: Adherence of 97.2 % to antiretroviral drugs was reported. The primary caregivers reported various methods they ...
AIDS Patient Care and STDs, 2011
Despite the need for HIV-positive children to adhere effectively to antiretroviral treatment (ART), a guiding theory for pediatric ART in resource-limited settings is still missing. Understanding factors that influence pediatric ART adherence is critical to developing adequate strategies. In-depth qualitative interviews were undertaken in Kinshasa, Democratic Republic of the Congo, with 20 sets of HIV disclosed and nondisclosed children along with respective caregivers to better characterize barriers, facilitators, and adherence experiences in children taking ART. Commonly cited barriers included lack of food or nutritional support, lack of assistance or supervision for children, lack of assistance for caregivers, and being unable to remember to take medicines on a consistent basis. Facilitators included having a strong caregiver-child relationship and support system along with strategies for maintaining adherence. Similar themes arose within the child-caregiver sets, but were often characterized differently between the two. Children who were aware of their HIV status displayed fewer instances of frustration and conflict concerning taking medicines and within the child-caregiver relationship. Continued study on pediatric ART adherence should account for differing perspectives of children and caregivers, as well as between status disclosed and nondisclosed children. Areas of future intervention should focus on child-caregiver relationships, disclosure of HIV status, and available nutritional and psychosocial support for children and their caregivers.
Acta Veterinaria Scandinavica, 2015
Background: 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. Methods: 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. Results: 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%). Conclusions: 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.
East African Medical Journal, 2015
Objective: To identify factors influencing anti-retroviral (ARV) drug adherence by HIV infected children aged 3 to 14 years attending Kericho District Hospital (KDH), Kenya. Design: A cross-sectional study Setting: Kericho District Hospital, Kenya Subjects: Two hundred and thirty (230) HIV infected children aged 3 to 14 years under caregivers who had been on ARV treatment for at least three months before study as verified by clinicians. Results: A total of 230 children aged between 3 and 14 years (mean age was 8.5 years ±3.2SD) were enrolled. Caregivers were aged between 16 and 90 years (mean age 34.6 years ± 10.4 SD). Majority, 178 (77.4%), of the caregivers were female and 137 (59.6%) were biological parents. ARV drug adherence levels, based on various methods of assessment, were sub-optimum, varied from 56.1% based on time of taking drugs, 49.1% based on pharmacy drug refills, 45.7% based on clinic appointments to 27.0% by pill counts.The key factors associated with adherence based on time of taking drugs were: caregiver being away from home (p=0.0010), caregiver forgetting to give drugs to the child (p=0.020), lack of disclosure of the child's HIV infection status (p=0.0080) and side effects experienced by the child (p=0.0120), lack of knowledge on treatment (p=0.0030) and stigma (p=0.0470). Based on clinic appointments, the factors included caregiver being away from home (p=0.004), lack of disclosure of the child's HIV infection (p=0.0000), side effects experienced by the child (p= 0.0030), stigma (p=0.0070) and transport cost (p=0.0240). Conclusion: The most important adherence factors among children were: caregiver being away from home, caregiver forgetting, lack of disclosure, child experiencing side effects, lack of knowledge and skills in managing the disease, stigma and transport costs to hospital.
BMC Pediatrics, 2013
Background: The introduction of Antiretroviral Therapy (ART) has brought a remarkable reduction in HIV-related mortality and morbidity both in adults and children living with HIV/AIDS. Adherence to ART is the key to the successful treatment of patients as well as containment of drug resistance. Studies based on caregivers' report have shown that adherence to ART among children is generally good. However, subjective methods such as caregivers' report are known to overestimate the level of adherence. This study determined the rate of adherence and its predictors using unannounced home-based pill count and compared the result with caregivers' report in a tertiary referral hospital in Ethiopia. Methods: A cross-sectional study was conducted between December 1, 2011 and January 30, 2012. The study participants were 210 children on ART and their caregivers attending pediatric ART clinic of Tikur Anbessa Hospital (TAH), Addis Ababa University. Caregivers were interviewed at the ART clinic using a structured questionnaire. Then, unannounced home-based pill count was done 7 days after the interview. Results: Caregiver-reported adherence in the past 7 days prior to interview was 93.3%. Estimated adherence using unannounced home-based pill count was found, however, to be 34.8%. On multivariate logistic regression model, children with married [aOR = 7.85 (95% CI: 2.11,29.13)] and widowed/divorced [aOR = 7.14 (95% CI: 2.00,25.46)] caregivers, those who were not aware of their HIV sero-status [aOR = 2.35 (95% CI:1.09, 5.06)], and those with baseline WHO clinical stage III/IV [OR = 3.18 (95% CI: 1.21, 8.40] were more likely to adhere to their ART treatment. On the other hand, children on d4T/3Tc/EFV combination [OR = 0.10 (95% CI: 0.02, 0.53)] were less likely to adhere to their treatment. Caregivers' forgetfulness and child refusal to take medication were reported as the major reasons for missing doses. Conclusion: The level of adherence based on unannounced home-based pill count was unacceptably low. Interventions are urgently needed to improve adherence to ART among children at TAH. Besides, a longitudinal study measuring adherence combined with clinical parameters (viral load and CD4 count) is needed to identify a simple and reliable measure of adherence in the study area.
AIDS Care, 2007
Adherence to antiretroviral (ART) therapy, as reported by children caregivers, was investigated and compared with physicians' estimates of adherence. Two parallel structured questionnaires were administered to caregivers of 129 HIVinfected children and to their physicians in seven different Italian reference centers. Doses omitted in the last four days were recorded. Perfect adherence (/95% of prescribed doses taken in the last four days before interview) was reported by caregivers of 103 (79%) children. Five children (5%) omitted one dose of any ART drug in four days and were considered adherent. Low (B/95 but /80% of doses) and poor (B/80% of doses) adherence were reported by 15 (12%) and six (5%) caregivers, respectively. Forty-eight children (37%) were judged to be non-adherent by their physicians, including 35 children who were receiving all the prescribed doses according to caregivers. The physicians identified eight out of the 21 non-adherent children as adherent. Non-adherence estimates by physicians closely correlated with poor clinical conditions. These data indicate that adherence is a major problem but there is a clear discrepancy between caregiver reports and physician judgement. The results underline the need of close surveillance of adherence in HIV-positive children in order to evaluate the effectiveness of ART therapy.