Adherence issues in children and adolescents receiving highly active antiretroviral therapy

Abstract

The introduction of highly active antiretroviral therapies (HAART) for the treatment of paediatric HIV infection poses additional adherence challenges for children and families living with HIV A preliminary survey of 18 parents of children receiving HAART in Australia showed that although parents report high level of child adherence to HAART, specific features of the medication regimen, such as taste and number of medications made administration of HAART extremely difficult.Moreover, interaction between the treatment regimen and the day-to-day lives of families increases the adherence challenge. While some agreement exists in relation to the concerns families have about negative aspects of HAART; the diversity of issues suggests the need for ongoing and individualized support and information to families.

Factors influencing adherence to anti-retroviral treatment in children with human immunodeficiency virus in South India – a qualitative study

“…These findings are consistent with earlier studies. (Boni, et al, 2000;Giacomet et al, 2003;Gibb et al, 2003;Goode et al, 2003;Martin et al, 2007;Pontali et al, 2001;Temple et al, 2001). While improving access to child-friendly formulations is vital, the use of simplified regimen, fixed dose combinations and less frequent dosing requirements, coupled with educating caregivers on the benefits and side effects of ART may also improve adherence (WHO, 2006; Working Group on Antiretroviral Therapy and the Medical Management of HIV-Infected Children, 2006).…”

“…This technique does not use pre-set questions, but is shaped by a defined set of topics. The topics (Table 1) were informed by a literature review of published studies relevant to factors influencing adherence in children (Bikaako-Kajura et al, 2006;Boni et al, 2000;Elise et al, 2005;Giacomet et al, 2003;Gibb et al, 2003;Goode et al, 2003;Hammami et al, 2004;Marhefka et al, 2006;Martin et al, 2007;Mellins et al, 2004;Nicholson et al, 2006;Pontali et al, 2001;Reddington et al, 2000;Temple et al, 2001;Williams et al 2006). All interviews were conducted by the principal investigator who had no role in the clinical care provided at the organisation.…”

“…Sustaining good adherence to ART in children is difficult as it is influenced by several factors including child behaviour, tolerability of medications, access to health services, HIV status of caregivers and their attitudes and beliefs (Bikaako-Kajura et al, 2006;Boni, Pontali, De Gol, Pedemonte & Bassetti, 2000;Elise et al, 2005;Giacomet et al, 2003;Gibb et al, 2003;Goode, McMaugh, Crisp, Wales & Ziegler, 2003;Hammami et al, 2004;Marhefka, Tepper, Brown, & Farley, 2006;Martin et al, 2007;Mellins, Brackis-Cott, Dolezal & Abrams, 2004;Nicholson et al, 2006;Pontali et al, 2001;Reddington et al, 2000;Temple, Koranyi, & Nahata, 2001;Williams et al 2006). Nonadherence leading to anti-viral resistance necessitates the use of more expensive and often more toxic second or third line drugs with disastrous implications at both individual and population levels (Mullen et al, 2002).…”

A drug dosage table is a useful tool to facilitate prescriptions of antiretroviral drugs for children in Thailand

“…15,16 Despite the importance of this issue, large multi-national pharmaceutical companies that have a monopoly on the manufacture of ARV drugs consider developing countries a poor market for their drugs.…”

How Do You Improve Compliance?

“…From the parental perspective, earlier studies reported that parents prefer oral liquid to solid forms (eg, powder, tablets, capsules), but compliance was measured in only some studies. [50][51][52] A recent randomized study of infants and toddlers with malaria demonstrated superior adherence to a regimen of crushed tablets when compared with syrup. 53 In a study of children with HIV, caregivers reported that it was easier to administer the tablet form of a medication than a large volume of powder.…”