Influence Antiretroviral Therapy Adherence Research Articles

Factors influencing adherence to antiretroviral therapy among young adults in Limpopo province.

South Africa is among the countries with the greatest burden of human immunodeficiency virus (HIV) in the world. The introduction of antiretroviral therapy (ART) has made HIV a manageable chronic health condition with a return to normal life expectancy. Adherence to ART is a prerequisite to realising these benefits. A qualitative study was conducted using individual semi-structured interviews to understand factors influencing adherence to ART among young adults. The study was conducted at three busy primary care clinics around Mankweng Hospital. Participants aged 18-35 years who had been on ART for more than a year were purposefully selected. Open-ended questions were used to explore factors that influence ART. Recorded interviews were transcribed verbatim and translated. The coded transcripts were thematically analysed. Eight major themes were identified to influence ART adherence among young adults: medication-related factors, healthcare system factors, attitudes of healthcare workers, economic factors, disclosure, acceptance, mobile phone reminders and family support. Adherence to ART is a major problem in our communities, and people living with HIV are still finding it challenging to optimally adhere to their ART medication because of the identified factors that influence ART adherence. Family support is a significant factor that was identified to positively influence ART as it leads to disclosure and acceptance of HIV-positive status, better emotional well-being and subsequently improved ART adherence.Contribution:This study underscores the importance of a family-oriented, patient-centred care approach in managing HIV and ART adherence.

Factors related ART adherence and quality of life in PLHIV: Mediating role of positive self-care management and brain gym

<b>Objectives: </b>To<b> </b>investigate the factors affecting adherence to antiretroviral therapy (ART) and the quality of life in people living with human immunodeficiency virus (HIV), with a focus on evaluating the mediating roles of positive self-care management (PSCM) and brain gym.<br /> <b>Methods:</b> This is a descriptive study with a cross-sectional design. The data collected from June to August 2023. There are 262 respondents selected through convenience sampling. We used various research instruments, including questionnaires, which have undergone validity and reliability testing. The data were analyzed using the SEM-PLS analysis method.<br /> <b>Results: </b>Our data analysis shows that condition factors, physical and social environmental factors, and individual and family factors affect HIV individuals’ PSCM and brain gym combination, ART adherence, and quality of life. Findings show that condition-specific factors indirectly affect antiretroviral drug adherence. This impact is mediated by PSCM and brain gym.<br /> <b>Conclusions: </b>Specific condition variables, namely<b><i> </i></b>complexity of the disease, barriers, and stability of conditions indirectly influence ART adherence, mediated through the combined influence of PSCM and brain gym. This finding suggests that to enhance adherence and the quality of life among PLHIV, it is important to adopt an approach that encompasses a range of internal and external individual factors.<b> </b>

Interaction of social support and depressive symptoms on antiretroviral therapy adherence among people living with HIV in South Africa.

Depression consistently emerges as a significant predictor of poor antiretroviral therapy (ART) adherence among adult people living with human immunodeficiency virus (PLHIV). However, a gap exists regarding how social support and depressive symptoms can interact to influence ART adherence among adult PLHIV in South Africa (SA). To investigate the interaction between social support and depressive symptoms on ART adherence among adult PLHIV. A tertiary hospital in Durban, KwaZulu-Natal province of SA. Utilising a quantitative cross-sectional research design along with time location sampling technique (TLS); the study recruited 201 adult patients enrolled in an ART programme. The results indicated that depressive symptoms were significantly associated with ART adherence with and without the interaction (B = -0.105; odds ratios [OR] 0.901; 95% confidence intervals [CI] = 0.827, 0.981; p = 0.016), while social support was not significantly associated with ART adherence (B = 0.007; OR 1.007; 95%CI = 0.989, 1.025; p = 0.475). However, a statistically significant interaction was found between social support and depressive symptoms (B = -0.006; OR 0.994; 95%CI = 0.989, 1.000; p = 0.037) on ART adherence. Based on the results, depressive symptoms significantly influenced ART adherence. However, social support did not buffer the adverse effects of clinical depression associated with poor ART adherence. This study provides an evidence-based approach to address gaps in the mental health and social well-being of PLHIV in the context of ART adherence.

Understanding the role of religious beliefs in adherence to antiretroviral therapy among Pentecostal Christians living with HIV in sub-Saharan Africa: a scoping review

BackgroundOptimum adherence to antiretroviral therapy (ART) is crucial in managing HIV. However, some people’s religious beliefs can influence how they deal with HIV and the psychosocial factors influencing their adherence to ART, such as disclosure, acceptance of HIV status, belief in ART, and depression. In sub-Saharan Africa (SSA), the role of religious beliefs in ART adherence is underexplored. We aimed to identify and conceptualize the literature on religious beliefs concerning ART adherence among Pentecostal Christians living with HIV in SSA.MethodsWe conducted a scoping review of the literature on religious beliefs and ART adherence. We searched papers from PubMed, Web of Science, Medline, Sabinet, Academic Search Complete, CINAHL Plus, Health Source/Nursing Academic, Scopus, and Google Scholar and published papers from conference proceedings and dissertations. Data were extracted according to a predetermined population, concept, context framework, and eligibility criteria for selecting or rejecting studies. We used a narrative synthesis to summarize the data on evidence and the impact of religious beliefs on ART adherence.ResultsSeven papers published between January 2010 and February 2022 met the inclusion criteria. Nineteen aspects of religious beliefs were identified as negatively influencing ART adherence, while eight aspects facilitated optimal adherence. “Being saved” or “born again” enhanced coping strategies for optimal adherence through actions such as less alcohol use, fidelity to a sexual partner(s), disclosure, acceptance of HIV status, reduced depression, and facilitated PLHIV to access social support from church members or other institutions.ConclusionReligious beliefs are integral to Pentecostal Christians living with HIV and affect their adherence to ART. While some Pentecostal Christians living with HIV on ART use their religious beliefs and practices to access psychosocial support from other church members or organizations and achieve good clinical outcomes, others apply their religious beliefs and practices differently and compromise their commitments to taking ART as prescribed, thus experiencing poor viral suppression and clinical outcomes. However, more research is required to understand and theorize how religious beliefs impact ART adherence among Pentecostals living with HIV to inform guidelines for practitioners.

Provider perspectives on antiretroviral therapy adherence among psychiatric inpatients in Botswana

Background: Optimal adherence to antiretroviral therapy (ART) is crucial for the effective management of HIV. Mental disorders often co-occur with HIV infection which often compromises ART adherence. Little is known about ART adherence in psychiatric settings in sub-Saharan Africa. Aims: This study aimed at exploring the health care providers’ perspectives on ART adherence among psychiatric inpatients. The study further assessed the facilitators and strategies enhancing ART adherence in hospitalised psychiatric patients. Methods: In-depth interviews were conducted with 25 health care providers at the Sbrana Psychiatric Hospital in Botswana. Interviews were focused on barriers and facilitators to psychiatric inpatients’ adherence to ART, and strategies and recommendations to support adherence. Data were manually analysed using a thematic analysis approach. Results: Key barriers were lack of insight, HIV-related stigma, lack of HIV-related knowledge, antiretroviral side effects and delays in re-initiating ART. Facilitators of ART adherence included motivation to be discharged from the hospital, fear of being sick, peer support, longer duration of hospitalisation, good provider-patient relationships, good diet, privacy and confidentiality and a single-tablet regimen. Health care providers described the various strategies currently used to support adherence, including directly observed therapy and family support, and recommended potential approaches to enhance psychiatric inpatient adherence to ART, including the use of injectable antiretrovirals and the introduction of halfway house centres. Conclusions: Findings from this study revealed unique insights into the numerous factors that influence ART adherence among psychiatric inpatients, and underscore the need to implement tailored strategies to support ART adherence in this population with complex health needs.

Perceptions About Local ART Adherence Norms and Personal Adherence Behavior Among Adults Living with HIV in Rural Uganda.

Although misperceived norms often drive personal health behaviors, we do not know about this phenomenon in the context of antiretroviral therapy (ART) adherence. We conducted a cross-sectional study including all persons living with HIV (PLWH) on ART across eight villages in one parish in a rural region of southwestern Uganda. We used surveys to measure personal reports of ART adherence (not missing any doses of ART in the past 7days was considered optimal adherence whereas missing doses was considered suboptimal adherence) and perceived norms about the local ART adherence norm (whether or not each individual thought 'most other PLWH on ART in this parish' missed any doses in the past 7days). Multivariable Poisson regression models were used toestimate the association between perceived norms and personal adherence. Among 159 PLWH on ART (95% response rate), 142 (89%) reported no missed doses. However, 119 (75%) thought most individuals in this population of PLWH on ART were sub-optimally adherent. This misperception about the local ART adherence norm was prevalent in every subgroup of PLWH. Misperceiving the local ART adherence norm to be sub-optimal adherence was associated with a reduced likelihood of optimal adherence among married PLWH (adjusted relative risk [aRR] = 0.83; 95% confidence interval [CI] 0.71-0.97). The association was similar but imprecisely estimated for all PLWH (aRR = 0.91; 95% CI 0.82-1.01). Interventions to correct misperceived ART adherence norms as a stand-alone intervention or as a complement to other adherence promotion programs may influence ART adherence behavior and perhaps reduce HIV-related stigma.

Determinants of HIV Treatment Adherence in Ethnically Diverse and Economically Disadvantaged Patients in a Tertiary Hospital, Nigeria

Antiretroviral Therapy (ART) Has Decreased The Mortality And Morbidity Of HIV/AIDS, And High Adherence To ART (>95%) Is Necessary For A Good Therapeutic Outcome. Non-Adherence Can Lead To Drug-Resistant HIV Caused By Failure To Achieve Maximal Viral Suppression. Little Is Known About Adherence To ART And Its Determinants Among Ethnically Diverse And Economically Disadvantaged Patients. The Purpose Of The Study Was To Identify The Level Of Adherence And Describe Factors That Influence ART Adherence Among Ethnically Diverse And Economically Disadvantaged Patients. This Is With A View To Providing Information That Could Help Health Care Providers Understand Patient Motivations For Discontinuing Their Antiretroviral Treatment And Helping Patients Collaboratively Develop Treatment Regimens That Facilitate Adherence And Optimize The Outcomes Of HIV/AIDS Therapy. A Cross-Sectional Descriptive Survey Was Used. Data Were Collected Among 400 HIV-Infected Patients On ARV Who Received Pretreatment And Ongoing Adherence Counseling And Education Since 2010 Using A Self-Administered Questionnaire. The Data Were Analyzed Using Statistical Package For Social Sciences (SPSS). Findings Showed That The Self-Reported Adherence To The Specific Timing For Taking The Medications (Medication Schedule) Was Significantly Low (8.3%). The Major Factors For Non-Adherence To Medication Reported In This Study Were Being Busy At Work Or School, Forgetfulness, Fasting And Travelling Away From Home. Also, Employment Status Was Associated With Poor Adherence, Which May Be Corroborated By The Major Reason For Non-Adherence (Busy At Work Or School). This Study Is One Of The First Steps In The Exploration Of The Relationship Of Factors Responsible And Medication Adherence Among HIV Patients. This Study Used Three Different Measures Of Medication Adherence. These Are Patients’ Knowledge Of The Benefits Of Taking The Drugs, Adherence To A Medication Schedule, And The Number Of Prescribed Doses Of Medications Missed. Health Care Providers Must Identify Possible Barriers To Adherence At The Earliest And Provide Appropriate Solutions. These Factors Should Be Considered When Designing And Implementing Adherence Interventions.

The Association Between Financial Resources Strain and Self-Reported Antiretroviral Therapy (ART) Adherence among HIV-Positive Men Who Have Sex with Men.

The purpose of this study was to assess the relationship between financial resources strain and self-reported ART adherence among men who have sex with men (MSM) who are living with HIV. Secondary data analyses were conducted with a sample of HIV-positive MSM (N = 77) who participated in a daily diary study on substance use and sexual behavior. Logistic regression was used to model the odds of self-reported ART adherence associated with financial resources strain. The adjusted model revealed a significant association between financial resources strain and self-reported ART adherence such that financially strained participants were 78.4% less likely to have "excellent" self-reported adherence ability compared with non-financially strained participants (aOR = .216, 95% CI [.063, .749], p = .016). Financial resources strain may negatively influence ART adherence. Future research should consider objectively measuring ART adherence. Health care providers might consider assessing patients' financial situation to identify those at-risk for nonadherence.

Assessing the relationship between knowledge of antiretroviral therapy and stigma regarding adherence to ART among men who have sex with men

This study aimed to assess the relationship between knowledge of antiretroviral therapy (ART) and stigma regarding adherence to ART. This cross-sectional study used a purposive sampling technique and involved 175 men who have sex with men (MSM), all of whom have HIV/AIDS. Levels of knowledge, stigma, and adherence were measured using the ART knowledge instrument, the Berger HIV Stigma Scale, and the Medication Adherence Questionnaire (MAQ), respectively. Most of the respondents had a high level of ART knowledge (76.6%), HIV-related stigma (51.4%), and non-adherence to ART (52%). The study showed a statistically significant negative correlation between stigma and adherence to ART (p=0.043; α=0.05). In addition, ART knowledge correlated positively with adherence to ART (p=0.010; α=0.05). Regression analysis showed that ART knowledge is an important factor influencing ART adherence (OR=2.817). It was found that as the level of ART knowledge increased, self-motivation and attitudes toward adherence to treatment increased.

Antiretroviral Adherence Following Prison Release in a Randomized Trial of the imPACT Intervention to Maintain Suppression of HIV Viremia.

Many people living with HIV (PLWH) pass through correctional facilities each year, a large proportion of whom do not maintain viral suppression following release. We examined the effects of imPACT, an intervention designed to promote post-release viral suppression, on antiretroviral therapy (ART) adherence. PLWH awaiting release from prisons in two southern states were randomized toimPACT(consisting of motivational interviewing, care linkage coordination, and text message medication reminders) versus standard care (SC). ART adherence, measured by unannounced monthly telephone pill counts, was compared between study arms over 6months post-release. Of 381 participants eligible for post-release follow-up, 302 (79%) completed ≥ 1 of 6 possible pill counts (median: 4; IQR 1-6). Average adherence over follow-up was 80.3% (95% CI 77.5, 83.1) and 81.0% (78.3, 83.6) of expected doses taken in the imPACT and SC arms, respectively. There was no difference between arms when accounting for missing data using multiple imputation (mean difference = - 0.2 percentage points [- 3.7, 3.3]), controlling for study site and week of follow-up. Of the 936 (40.9%) pill counts that were missed, 212 (22.7%) were due to re-incarceration. Those who missed pill counts for any reason were more likely to be unsuppressed, suggesting that they had lower adherence. However, missingness was balanced between arms. Among PLWH released from prison, ART adherence averaged > 80% in both study arms over 6months-a level higher than seen with most other chronic diseases. However, missing data may have led to an overestimate of adherence. Factors independent of the intervention influence ART adherence in this population and should be identified to inform future targeted interventions.

Depression, Social Support, and Adherence to Antiretroviral Therapy Among People Living With HIV in Guangxi, China: A Longitudinal Study.

Depression can result in poor adherence to antiretroviral therapy (ART) among people living with HIV (PLHIV), and social support can help mitigate the negative relationship. However, little is known about how depression and social support synergistically influence ART adherence over time. The current study aims to explore longitudinal associations between them and examine which sources of social support can play a mediating role between depression and ART adherence over time. A randomized controlled clinical trial was conducted between 2013 and 2016 in Guangxi, China. The study sample was composed of 319 PLHIV who were randomized into control condition and provided data at baseline and at least one of the six follow-ups. The results revealed negative associations of depression with ART adherence over time, and a mediating effect of perceived support from spouse/partner or children. Interventions to promote ART adherence should focus on strengthening PLHIV's relationships with their spouse/partner and children, promoting collaborative provider-patient relationships, and enhancing peer support among PLHIV.

Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects.

Following global efforts to increase antiretroviral therapy (ART) access in Sub-Saharan Africa, ART coverage among HIV-infected Cameroonians increased from 0% in 2003 to 22% in 2014. However, the success of current HIV treatment programs depends not only on access to ART, but also on retention in care and good treatment adherence. This is necessary to achieve viral suppression, prevent virologic failure, and reduce viral transmission and HIV/AIDS-related deaths. Previous studies in Cameroon showed poor adherence, treatment interruption, and loss to follow-up among HIV+ subjects on ART, but the factors that influence ART adherence are not well known. In the current cross-sectional study, patient/self-reported questionnaires and pharmacy medication refill data were used to quantify ART adherence and determine the factors associated with increased risk of non-adherence among HIV-infected Cameroonians. We demonstrated that drug side-effects, low CD4 cell counts and higher viral loads are associated with increased risk of non-adherence, and compared to females, males were more likely to forego ART because of side effects (p<0.05). Univariate logistic regression analysis demonstrated that subjects with opportunistic infections (on antibiotics) had 2.42-times higher odds of having been non-adherent (p<0.001). Multivariable analysis controlling for ART regimen, age, gender, and education showed that subjects with opportunistic infections had 3.1-times higher odds of having been non-adherent (p<0.0003), with significantly longer periods of non-adherence, compared to subjects without opportunistic infections (p = 0.02). We further showed that compared to younger subjects (≤40 years), older subjects (>40 years) were less likely to be non-adherent (p<0.01) and had shorter non-adherent periods (p<0.0001). The presence of depression symptoms correlated with non-adherence to ART during antibiotic treatment (r = 0.53, p = 0.04), and was associated with lower CD4 cell counts (p = 0.04) and longer non-adherent periods (p = 0.04). Change in ART regimen was significantly associated with increased likelihood of non-adherence and increased duration of the non-adherence period. Addressing these underlying risk factors could improve ART adherence, retention in care and treatment outcomes for HIV/AIDS patients in Cameroon.

Examining the interplay between depression, motivation, and antiretroviral therapy adherence: a social cognitive approach

ABSTRACTA large body of research identifies depressive symptoms as a barrier to optimal antiretroviral therapy (ART) adherence, whereas treatment motivation has been characterized as a facilitator. There is evidence, however, that these patterns may not hold for some ART patients despite the widespread use of motivational techniques aimed at promoting adherence. Little is known about how the interplay between different levels of depressive symptoms and variations in the types and levels of motivation may influence ART adherence. The purpose of this study was to examine the relationship between depressive symptoms, two types of motivation, and adherence, with self-efficacy as a mediator. The sample consisted of 121 ART patients who reported various levels of depressive symptoms (mean age = 41 years; 84% African-American; and 68% female). Path analysis revealed that self-efficacy fully mediated the relationship between the three predictor variables (depressive symptoms, intrinsic motivation, and extrinsic motivation) and adherence, χ2(3, N = 121) = .78, RMSEA = .00, SRMR = .02, CFI = 1.00, NNFI = 1.06. Findings suggest that interventions using motivational techniques to build adherence among patients with varying levels of depressive symptoms should address the role of treatment self-efficacy to improve their effectiveness.

Video observations of treatment administration to children on antiretroviral therapy in rural KwaZulu-Natal

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.

Alcohol Interactive Toxicity Beliefs and ART Non-adherence Among HIV-Infected Current Drinkers in Mbarara, Uganda.

Interactive toxicity beliefs regarding mixing alcohol and antiretroviral therapy (ART) may influence ART adherence. HIV-infected patients in Uganda completed quarterly visits for 1year, or one visit at 6months, depending on study randomization. Past month ART non-adherence was less than daily or <100% on a visual analog scale. Participants were asked if people who take alcohol should stop taking their medications (belief) and whether they occasionally stopped taking their medications in anticipation of drinking (behavior).Visits with self-reported alcohol use and ART use for ≥30days were included. We used logistic regression to examine correlates of the interactive toxicity belief and behavior, and to determine associations with ART non-adherence. 134 participants contributed 258 study visits. The toxicity belief was endorsed at 24%, the behavior at 15%, and any non-adherence at 35% of visits. In multivariable analysis, the odds of non-adherence were higher for those endorsing the toxicity behavior [adjusted odds ratio (AOR) 2.06; 95% confidence interval (CI) 0.97-4.36] but not the toxicity belief (AOR 0.63; 95% CI 0.32-1.26).Clear messaging about maintaining adherence, even if drinking, could benefit patients.

Correlates of Antiretroviral Therapy Adherence among HIV-Infected Older Adults.

Despite the success of antiretroviral therapy (ART), HIV-infected older African Americans experience higher mortality rates compared to their white counterparts. This disparity may be partly attributable to the differences in ART adherence by different racial and gender groups. The purpose of this study was to describe demographic, psychosocial, and HIV disease-related factors that influence ART adherence and to determine whether race and gender impact ART adherence among HIV-infected adults aged 50 years and older. This descriptive study involved a secondary analysis of baseline data from 426 participants in "PRIME," a telephone-based ART adherence and quality-of-life intervention trial. Logistic regression was used to examine the association between independent variables and ART adherence. Higher annual income and increased self-efficacy were associated with being ≥95% ART adherent. Race and gender were not associated with ART adherence. These findings indicated that improvements in self-efficacy for taking ART may be an effective strategy to improve adherence regardless of race or gender.

Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review

Adolescents living in low- and middle-income countries (LMICs) are disproportionately burdened by the global HIV/AIDS pandemic. Maintaining medication adherence is vital to ensuring that adolescents living with HIV/AIDS receive the benefits of antiretroviral therapy (ART), although this group faces unique challenges to adherence. Knowledge of the factors influencing adherence among people during this unique developmental period is needed to develop more targeted and effective adherence-promoting strategies. This systematic review summarizes the literature on quantitative observational studies examining correlates, including risk and resilience-promoting factors, of ART adherence among adolescents living with HIV/AIDS in LMICs. A systematic search of major electronic databases, conference-specific databases, gray literature, and reference lists of relevant reviews and documents was conducted in May 2014. Included studies examined relationships between at least one factor and ART adherence as an outcome and were conducted in primarily an adolescent population (age 10–19) in LMICs. The search identified 7948 unique citations from which 15 studies fit the inclusion criteria. These 15 studies identified 35 factors significantly associated with ART adherence representing a total of 4363 participants across nine different LMICs. Relevant studies revealed few consistent relationships between measured factors and adherence while highlighting potentially important themes for ART adherence including the impact of (1) adolescent factors such as gender and knowledge of serostatus, (2) family structure, (3) the burdensome ART regimens, route of administration, and attitudes about medication, and (4) health care and environmental factors, such as rural versus urban location and missed clinic appointments. Rates of adherence across studies ranged from 16% to 99%. This review identifies unique factors significantly related to ART adherence among adolescents living in LMICs. More research using longitudinal designs and rigorous measures of adherence is required in order to identify the range of factors influencing ART adherence as adolescents living with HIV/AIDS in LMICs grow into adulthood.

Factors associated with antiretroviral treatment interruption in human immunodeficiency virus (HIV)-1-infected children attending the Jos University Teaching Hospital, Jos, Nigeria.

Background:Interrupting anti-retroviral therapy (ART) for any number of reasons is an indication of a compromised adherence to ART. Several factors, including the pill burden from other drugs used in treating co-infections in children with human immunodeficiency virus (HIV), may influence ART adherence. The aim of this study was to identify the factors associated with ART interruption in HIV-1-infected children.Materials and Methods:A retrospective cohort study analysing data on 580 children consecutively enrolled on ART between February 2006 and December 2010 at the paediatric HIV clinic of Jos University Teaching Hospital (JUTH), Jos. Subjects were children aged 2 months — 15 years diagnosed with HIV-1 infection and on first-line ART. Cotrimoxazole prophylaxis was usually commenced at diagnosis while awaiting ART commencement. Children diagnosed with tuberculosis (TB) were also placed on multiple individual anti-TB drugs.Statistical analysis used:A comparison of the data on children with and without ART interruption was made. Variables associated with ART interruption in a univariate analysis were fit in a multivariate logistic model to determine the factors that were associated with ART interruption.Results:Children on anti-TB drugs were twice more likely to interrupt ART compared to those who were not, (adjusted odds ratio, AOR = 1.84 (1.03-3.28); P = 0.04). But children on cotrimoxazole prophylaxis had a 57% reduction in the odds of interrupting ART compared to those who were not, (AOR = 0.43 (0.20-0.93); P = 0.03).Conclusion:Children on ART and also taking multiple individual anti-TB drugs should be monitored closely for ART adherence. Cotrimoxazole prophylaxis should be encouraged in children diagnosed with HIV while awaiting ART commencement as this may prime them for a better ART adherence.

Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis.

ObjectiveTo assess the association between the employment status of human immunodeficiency virus (HIV)-infected individuals and adherence to antiretroviral therapy (ART).MethodsWe searched the Medline, Embase and Cochrane Central Register of Controlled Trials databases for studies reporting ART adherence and employment status published between January 1980 and September 2014. Information from a wide range of other sources, including the grey literature, was also analysed. Two independent reviewers extracted data on treatment adherence and study characteristics. Study data on the association between being employed and adhering to ART were pooled using a random-effects model. Between-study heterogeneity and sources of bias were evaluated.FindingsThe meta-analysis included 28 studies published between 1996 and 2014 that together involved 8743 HIV-infected individuals from 14 countries. The overall pooled odds ratio (OR) for the association between being employed and adhering to ART was 1.27 (95% confidence interval, CI: 1.04–1.55). The association was significant for studies from low-income countries (OR: 1.85, 95% CI: 1.58–2.18) and high-income countries (OR: 1.33, 95% CI: 1.02–1.74) but not middle-income countries (OR: 0.94, 95% CI: 0.62–1.42). In addition, studies published after 2011 and larger studies showed less association between employment and adherence than earlier and small studies, respectively.ConclusionEmployed HIV-infected individuals, particularly those in low- and high-income countries, were more likely to adhere to ART than unemployed individuals. Further research is needed on the mechanisms by which employment and ART adherence affect each other and on whether employment-creation interventions can positively influence ART adherence, HIV disease progression and quality of life.

What makes orphans in Kigali, Rwanda, non-adherent to antiretroviral therapy? Perspectives of their caregivers.

IntroductionEvery year, approximately 260,000 children are infected with HIV in low- and middle-income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV-positive children. We need to develop a better understanding of the background of children's ART non-adherence because it is not well understood. The purpose of this study is to explore the background related to ART non-adherence, specifically in relation to the orphan status of children in Kigali, Rwanda.MethodsWe conducted 19 focus group discussions with a total of 121 caregivers of HIV-positive children in Kigali. The primary data for analysis were verbatim transcripts and socio-demographic data. A content analysis was performed for qualitative data analysis and interpretation.ResultsThe study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans’ caregivers, and feelings of guilt about the child's condition among non-orphaned caregivers.ConclusionsKnowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV-positive children. In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.