Abstract
BackgroundThe introduction of combination antiretroviral therapy (ART) has resulted in striking reductions in HIV-related mortality. Despite increased availability of ART, children remain a neglected population. This may be due to concerns that failure to adhere appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV. This study determines the rates and factors associated with adherence to Antiretroviral (ARV) Drug therapy in HIV-infected children who were receiving Highly Active Antiretroviral Therapy (HAART) in Addis Ababa, Ethiopia in 2008.MethodsA cross-sectional study was conducted in five hospitals in Addis Ababa from February 18 – April 28, 2008. The study population entailed parents/caretaker and index children who were following ART in the health facilities. A structured questionnaire was used for data collection.ResultsA total of 390 children respondents were included in the study with a response rate of 91%. The majority, equaling 205 (52.6%) of the children, were greater than 9 years of age. Fifty five percent of the children were girls. A total of 339 children (86.9%) as reported by caregivers were adherent to antiretroviral drugs for the past 7 days before the interview. Numerous variables were found to be significantly associated with adherence: children whose parents did not pay a fee for treatment [OR = 0.39 (95%CI: 0.16, 0.92)], children who had ever received any nutritional support from the clinic [OR = 0.34 (95%CI: 0.14, 0.79)] were less likely to adhere. Whereas children who took co-trimoxazole medication/syrup besides ARVs [OR = 3.65 (95%CI: 1.24, 10.74)], children who did not know their sero-status [OR = 2.53 (95%CI: 1.24, 5.19)] and children who were not aware of their caregiver's health problem [OR = 2.45 (95%CI: 1.25, 4.81)] were more likely to adhere than their counterparts.ConclusionAdherence to HAART in children in Addis Ababa was higher than other similar setups. However, there are still significant numbers of children who are non-adherent to HAART.
Highlights
The introduction of combination antiretroviral therapy (ART) has resulted in striking reductions in HIV-related mortality
The study subjects were on Highly Active Antiretroviral Therapy (HAART) for a mean and median duration of 20 and 24 months (12 to 48 month)
Factors Associated With Pediatric Adherence to Antiretroviral Therapy After controlling the effects of other variables, five variables were found to be significantly associated with adherence to ART in children: As shown in Table 4, children whose parents did not pay a fee for treatment were 61.3% less likely to adhere for ART than those who paid for their medication [OR = 0.39 (95%CI: 0.16, 0.92)]
Summary
The introduction of combination antiretroviral therapy (ART) has resulted in striking reductions in HIV-related mortality. Despite increased availability of ART, children remain a neglected population. This may be due to concerns that failure to adhere appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV. In 2007 an estimated 33.2 million people were living with HIV (PLHIV) worldwide, while 2.5 million of these people were children under 15 years old. 420,000 Children under 15 years were newly infected with HIV in 2007. Every day there are nearly 1200 new infections in children under 15 years of age with more than 90% of these occurring in the developing world and most being associated with MTCT [3]
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