Adherence to Antiretroviral Therapy and associated factors among HIV infected children in Ethiopia: unannounced home-based pill count versus caregivers’ report

Abstract

BackgroundThe introduction of Antiretroviral Therapy (ART) has brought a remarkable reduction in HIV-related mortality and morbidity both in adults and children living with HIV/AIDS. Adherence to ART is the key to the successful treatment of patients as well as containment of drug resistance. Studies based on caregivers’ report have shown that adherence to ART among children is generally good. However, subjective methods such as caregivers’ report are known to overestimate the level of adherence. This study determined the rate of adherence and its predictors using unannounced home-based pill count and compared the result with caregivers’ report in a tertiary referral hospital in Ethiopia.MethodsA cross-sectional study was conducted between December 1, 2011 and January 30, 2012. The study participants were 210 children on ART and their caregivers attending pediatric ART clinic of Tikur Anbessa Hospital (TAH), Addis Ababa University. Caregivers were interviewed at the ART clinic using a structured questionnaire. Then, unannounced home-based pill count was done 7 days after the interview.ResultsCaregiver-reported adherence in the past 7 days prior to interview was 93.3%. Estimated adherence using unannounced home-based pill count was found, however, to be 34.8%. On multivariate logistic regression model, children with married [aOR = 7.85 (95% CI: 2.11,29.13)] and widowed/divorced [aOR = 7.14 (95% CI: 2.00,25.46)] caregivers, those who were not aware of their HIV sero-status [aOR = 2.35 (95% CI:1.09, 5.06)], and those with baseline WHO clinical stage III/IV [OR = 3.18 (95% CI: 1.21, 8.40] were more likely to adhere to their ART treatment. On the other hand, children on d4T/3Tc/EFV combination [OR = 0.10 (95% CI: 0.02, 0.53)] were less likely to adhere to their treatment. Caregivers’ forgetfulness and child refusal to take medication were reported as the major reasons for missing doses.ConclusionThe level of adherence based on unannounced home-based pill count was unacceptably low. Interventions are urgently needed to improve adherence to ART among children at TAH. Besides, a longitudinal study measuring adherence combined with clinical parameters (viral load and CD4 count) is needed to identify a simple and reliable measure of adherence in the study area.

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

“…This is particularly relevant for a setting where forgetfulness is the most common reason for missing as reported both in the present and previous studies (Biadgilign et al, 2008;Biressaw et al, 2013).…”

“…Studies from Ethiopia reported that ART treatment adherence in children ranged from 78.6% to 93.3% (Arage, Tessema, & Kassa, 2014;Biadgilign, Deribew, Amberbir, & Deribe, 2008;Biressaw, Abegaz, Abebe, Taye, & Belay, 2013). A study conducted in sub-Saharan Africa indicated that ART adherence during the first six months of treatment predicted the prognostic value of virological and immunological responses and subsequent survival among adults (De Luca et al, 2012).…”

Using Lopinavir Concentrations in Hair Samples to Assess Treatment Outcomes on Second-Line Regimens Among Asian Children

“…3,[17][18][19][20] Compared to hair drug levels, our study found that measuring adherence using 30-day self-report with VAS, pill count, or even TDM via single plasma samples was less sensitive in identifying chronically poor adherence (as adjudicated by virologic failure). Moreover, self-reported adherence was high (median 100%), despite variability in hair concentrations.…”

Adherence to Highly Active Antiretroviral Therapy Among Children in Ethiopia: A Systematic Review and Meta-analysis

“…Three studies conducted in Amhara region [46, 47, 55], two in Oromia [52, 54], two in Tigray [50, 53], two in Addis Ababa [45, 48], one in Oromia and Addis Ababa [51] and one in Harare and Dire Dawa city [49]. Five studies reported the prevalence of optimal adherence both at 07 days and 03 days prior to an interview [46, 47, 49, 50, 53] whereas five studies reported only prevalence at 07 days prior to an interview [45, 48, 51, 52, 54]. One study reported the prevalence of optimal adherence at 03 days prior to an interview [55].…”

“…Optimal adherence to HAART among included studies in this meta-analysis was defined as according to caregiver report if children took ≥ 95% of the prescribed doses for 07 days [45–54] and 03 days [46, 47, 49, 50, 53, 55] prior to an interview. Qualitative studies and citations without full-text were excluded.…”