Abstract
BackgroundAntiretroviral therapy (ART) dramatically improves outcomes for children in Africa; however excellent adherence is required for treatment success. This study describes the utility of different measures of adherence in detecting lapses in infants and young children in Cape Town, South Africa.MethodsIn a prospective cohort of 122 HIV-infected children commenced on ART, adherence was measured monthly during the first year of treatment by medication return (MR) for both syrups and tablets/capsules. A questionnaire was administered to caregivers after 3 months of treatment to assess experience with giving medication and self-reported adherence. Viral and immune response to treatment were assessed at the end of one year and associations with measured adherence determined.ResultsMedication was returned for 115/122 (94%) children with median age (IQR) of 37 (16 – 61) months. Ninety-one (79%) children achieved annual average MR adherence ≥ 90%. This was an important covariate associated with viral suppression after adjustment for disease severity (OR = 5.5 [95%CI: 0.8–35.6], p = 0.075), however was not associated with immunological response to ART. By 3 months on ART, 13 (10%) children had deceased and 11 (10%) were lost to follow-up. Questionnaires were completed by 87/98 (90%) of caregivers of those who remained in care. Sensitivity of poor reported adherence (missing ≥ 1 dose in the previous 3 days) for MR adherence <90% was only 31.8% (95% CI: 10.7% – 53.0%). Caregivers of 33/87 (38.4%) children reported difficulties with giving medication, most commonly poor palatability (21.8%). Independent socio-demographic predictors of MR adherence ≥ 90% were secondary education of caregivers (OR = 4.49; 95%CI: 1.10 – 18.24) and access to water and electricity (OR = 2.65; 95%CI: 0.93 – 7.55). Taking ritonavir was negatively associated with MR adherence ≥ 90% (OR = 0.37; 95%CI: 0.13 – 1.02).ConclusionExcellent adherence to ART is possible in African infants and young children and the relatively simple low technology measure of adherence by MR strongly predicts viral response. Better socio-economic status and more palatable regimens are associated with better adherence.
Highlights
Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; excellent adherence is required for treatment success
While antiretroviral therapy (ART) of children in Africa has resulted in dramatically improved survival, clinical, immunological and virological status, less than 15% of children needing ART on the continent currently receive it. [2,3,4,5,6,7,8,9,10,11] Excellent adherence is one of the most important factors in determining treatment success and preventing viral resistance, and the need for near-perfect adherence to lifelong therapy from an early age has been identified as a major challenge in the administration of ART to HIV-infected children.[10,12,13,14,15]
This study extends to infants and young children the finding that good adherence to ART in Africa is achievable with nearly 80% of children obtaining average medication return (MR) adherence ≥ 90% over the first year of ART. [16,25,26,28] This is at least as good as pediatric adherence in rich countries.[13,17,18,19,20,21,22]
Summary
Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; excellent adherence is required for treatment success. While African adult studies show that good adherence to ART is possible despite poor social circumstances, there are limited studies in African children.[16,24,25,26,27] Health service challenges as well as individual factors such as poor socio-economic circumstances, poor literacy and the prohibitive cost of liquid drug formulations necessitating tablet/capsule administration to very young children are additional potential barriers to adherence in African children.[10,15] In Kampala, Uganda, 72% of children aged 2–18 years had adherence ≥ 95% measured with homebased unannounced pill counts, compared to 89% using 3-day self-reported adherence and 94% using clinic-based pill counts.[28] Muller et al found discrepant results using different measures of adherence in young children (median age 38 months) in South Africa.[29] Using electronic means (Medication Event Monitoring System (MEMS)) to monitor adherence, only 36% of patients achieved ≥ 95% adherence, in comparison to 91% of caregivers reporting excellent adherence on a visual analogue scale.[29] The only other published adherence studies of African children include only older children and measure self-reported adherence only, with varying results. All published African studies have been conducted over short periods (≤ 3 months), mostly in older chidren, and may not reflect longer term adherence patterns in very young children
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
