Abstract
ABSTRACTFor children younger than five years, caregivers are responsible for the measurement and administration of antiretroviral medication doses to children. Failure to adhere to the regimen as prescribed may lead to high viral loads (VLs), immune suppression and ultimately drug resistance. In the content of this study, adherence refers to adequate dosing of the medication by a caregiver. Acquired drug resistance to antiretroviral therapy (ART) is prevalent amongst children in South Africa, and poor adherence to the dosing regimen by caregivers may be associated with this problem. In this qualitative study, we purposively recruited 33 caregiver–child dyads from the Hlabisa HIV Treatment and Care Programme database. Children were divided into three groups based on their VL at the time of recruitment. Children with a VL ≥ 400 cps/ml were grouped as unsuppressed (n = 11); children with a VL ≤ 400 cps/ml were grouped as suppressed (n = 12); and children with no VL data were grouped as newly initiated (n = 10). Caregiver–child dyads were visited at their households twice to document, by means of video recording, how treatment was administered to the child. Observational notes and video recordings were entered into ATLAS.ti v 7 and analysed thematically. Results were interpreted through the lens of Ecological Systems Theory and the information–motivation–behavioural skills model was used to understand and reflect on several of the factors influencing adherence within the child’s immediate environment as identified in this study. Thematic video analysis indicated context- and medication-related factors influencing ART adherence. Although the majority of children in this sample took their medicine successfully, caregivers experienced several challenges with the preparation and administration of the medications. In the context of emerging drug resistance, efforts are needed to carefully monitor caregiver knowledge of treatment administration by healthcare workers during monthly clinic visits.
Highlights
In the context of limited antiretroviral (ARV) drug options available for adults and children in South Africa (Davies et al, 2011), adherence to a first-line regimen is key to ensure optimal and prolonged benefits of treatment (Bangsberg et al, 2000; Bangsberg et al, 2003)
According to the latest guidelines on antiretroviral therapy (ART) initiation among infants, children and adolescents in South Africa, all children younger than five years old should be initiated on ART and are usually initiated on a first-line ART regimen (Department of Health South Africa, 2014)
The median age of the children at recruitment was 3.5 years (interquartile range (IQR), 2–4.75) for those with suppressed viral loads (VLs), 4 years (IQR: 3–5) for those with unsuppressed VLs and 2 years (IQR: 2–5) for those newly initiated on ART
Summary
In the context of limited antiretroviral (ARV) drug options available for adults and children in South Africa (Davies et al, 2011), adherence to a first-line regimen is key to ensure optimal and prolonged benefits of treatment (Bangsberg et al, 2000; Bangsberg et al, 2003). For children younger than five years who rely on parental or non-parental caregivers to administer their medication to them daily, adherence becomes an even greater task to manage. In the absence of fixed-dose combinations available to children younger than five years, caregivers of children in this age group are required to carefully and accurately measure and administer volumes of liquid drug formulations to children on ART twice a day (World Health Organisation [WHO], 2013).
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