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Abstract
IntroductionThe efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patient's adherence. Adherence in children poses peculiar challenges. The aim of the study was to determine the adherence level and factors influencing adherence among HIV-infected children and adolescents in University of Port Harcourt Teaching Hospital, Nigeria.MethodsA cross-sectional survey of HIV-infected children and adolescents on ART using self-report by the caregiver/child in the past one month.ResultsA total of 213 caregivers and their children were interviewed. A hundred and sixty-two (76.1%) had adherence rates ≥95%. Only 126 (59.2%) were completely (100%) adherent. The commonest caregiver-related factors for missing doses were forgetfulness 48(55.2%), travelled 22(25.3%) and drugs finished 16(18.4%), while the child-related factors were refused drugs 10(11.5%), slept 8(9.2%), and vomited 8(9.2%). Sixty-eight (31.9%) caregivers reported missing clinic visit and reasons given were travelled 18(26.5%), caregiver ill 12(17.6%) and family problems 9(13.2%). Predictors of poor adherence include mother as the primary caregiver (OR 3.32; 95%CI, 1.33-8.67), younger than 5years (OR 2.62; 95%CI, 1.30-5.31) and presence of a co-morbidity (OR 3.97; 95%CI, 1.92-8.33). Having a medication reminder strategy (OR 6.34; 95%CI, 3.04-13.31), regular clinic visits (OR 8.55; 95%CI 4.01-18.45) and status disclosure (p = 0.008) predicted a better adherence. The caregiver's age (p= 0.11), education (p = 0.86), socioeconomic status (p = 0.89), gender of the child (p = 0.84), type of ART (p = 0.2) and duration of ART (1.0) did not significantly affect adherence.ConclusionAdherence is still suboptimal. Since barriers to Paediatric ART adherence are largely caregiver-dependent, identifying and addressing these barriers in each caregiver-child pair will improve adherence and patient outcome.
Highlights
The efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patient’s adherence
Maintaining adequate levels of adherence to antiretroviral medications has proved challenging for persons living with Human Immunodeficiency Virus (HIV), and for healthcare providers [1, 3] because a failing regime as a result of poor adherence will lead to increased opportunistic infections, increased hospitalization and outpatient visits and increased work load
The unit provides care and treatment for all HIV exposed and infected children presenting in University of Port Harcourt Teaching Hospital (UPTH)
Summary
The efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patient’s adherence. The Human Immunodeficiency Virus (HIV) infection remains a major public health crisis in Nigeria and has continued to spread at an alarming rate among children In response to this pandemic, many countries including Nigeria have developed care and treatment programs. This will in turn reduce the destruction of CD4 cells, reduce immune suppression and slow disease progression [1] These benefits can only be achieved through consistent adherence to antiretroviral drugs in order to maintain adequate drug levels in the body. Maintaining adequate levels of adherence to antiretroviral medications has proved challenging for persons (especially children) living with HIV, and for healthcare providers [1, 3] because a failing regime as a result of poor adherence will lead to increased opportunistic infections, increased hospitalization and outpatient visits and increased work load. Non-adherence may eventually mar the dramatic improvements in HIV-related health parameters
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