Adherence to paediatric antiretroviral therapy in South Africa

Abstract

Introduction. In South Africa, the HIV epidemic has risen sharply in numbers over the past decade, and a growing number of children are treated with antiretroviral therapy. This study aimed to examine adherence in a paediatric outpatient cohort and to compare an objective electronic monitoring system to subjective caregivers self-reports. It also assessed the impact of social determinants on adherence and antiretroviral treatment outcome.Methods. Seventy-eight children and their caregivers were monitored prospectively over 3 months. Adherence was measured with the Medication Event Monitoring System (MEMS) and by caregivers self-report on a Visual Analogue Scale (VAS). A specifically designed questionnaire examined individual cultural beliefs about HIV and its treatment, and socio-economic data were collected by caregiver report. Virological data were available for study baseline and follow-ups.Results. Adherence was lower when measured by MEMS (88%) than when measured by VAS (100%). MEMS adherence was a significant predictor of virological outcome. Socio-economic factors were not associated with adherence. Caregivers beliefs in the efficacy of antiretroviral treatment and higher knowledge thereof were linked to better adherence levels; while social stigma was associated with lower adherence levels.Discussion. This first study of paediatric adherence in South Africa shows that adherence levels are as good as in developed countries, but not high enough to sustain therapeutic success. MEMS seems to be a more accurate method to measure adherence than VAS, and is feasible with liquid formulations and in resource-limited settings. Further research is needed to disentangle the complex relationship of adherence, caregiver knowledge, attitudes and therapeutic success and a qualitative heuristic methodology should be considered.