Assessing Adherence to Antiretroviral Therapy in a Rural Paediatric Cohort in KwaZulu-Natal, South Africa

Smith, C; Gengiah, Tanuja N.; Yende‐Zuma, Nonhlanhla; Upfold, Michele; Naidoo, Kogieleum

doi:10.1007/s10461-016-1419-5

Cited by 8 publications

(5 citation statements)

References 34 publications

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“…Objective measures consist of pharmacy refill pill count, electronic dose monitoring, drug detection in biologic samples and plasma HIV Viral load (VL); they are generally costly and sometimes less accepted by the patients [ 9 ]. Due to these advantages and disadvantages, a combination of multiple techniques has been suggested for better adherence assessment [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Adherence to antiretroviral treatment among children and adolescents in Tanzania: Comparison between pill count and viral load outcomes in a rural context of Mwanza region

Martelli

Antonucci²,

Mukurasi³

et al. 2019

PLoS ONE

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Background and objectivesAdherence to antiretroviral treatment is a key challenge for paediatric HIV care. Among children and adolescents living with HIV, lower levels of adherence have been reported compared to adults. Individual, caregiver-, health services-related and sociocultural factors were shown to impact on these outcomes. Study objectives were to assess adherence in a paediatric population in rural Tanzania comparing two measurement methods, and to investigate the association between virologic suppression and demographic, clinical, drug- and family-related factors.MethodsThis cross-sectional study was conducted among children and adolescents enrolled in Bukumbi HIV Care and Treatment Clinic (Misungwi district, Mwanza region) in the north of Tanzania, where the HIV prevalence is 7.2%. Adherence was measured through viral load and pill count. Kappa statistics assessed the level of agreement between the methods; bivariate and multivariable analyses identified factors independently associated with virologic suppression.ResultsN = 72 participants (n = 49 children; n = 23 adolescents) with a median age of eight years were enrolled. 62.5% and 65.3% of the individuals presented an optimal adherence according to viral load and pill count respectively, but among 40% viral load results diverged from the pill count method. In multivariable analysis, living outside Misungwi district and having CD4 counts above 500/μl were significantly associated with optimal adherence.ConclusionChildren and adolescents living with HIV in Mwanza show high rates of suboptimal adherence. The poor agreement between pill count and viral load results raises concerns about the interpretation of these measurements in clinical practice.

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Section: Introductionmentioning

confidence: 99%

Adherence to antiretroviral treatment among children and adolescents in Tanzania: Comparison between pill count and viral load outcomes in a rural context of Mwanza region

Martelli

Antonucci²,

Mukurasi³

et al. 2019

PLoS ONE

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“…ART reduces plasma viremia, increases the CD4 cell count, and ultimately improves the health of children living with HIV. Despite the benefits and availability of ART, medication adherence remains suboptimal among children living with HIV due to multiple barriers, notably reliance on caregivers and guardians to regularly administer medication [6][7][8]. In addition, ART may be associated with toxicities and adverse side effects that include anaemia [9], metabolic abnormalities [10][11][12], and reduced growth [10,11].…”

Section: Introductionmentioning

confidence: 99%

Caregivers of children with HIV in Botswana prefer monthly IV Broadly Neutralizing Antibodies (bNAbs) to daily oral ART

Sakoi-Mosetlhi,

Ajibola,

Haghighat

et al. 2024

PLoS ONE

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Introduction Monthly intravenous infusion of broadly neutralizing monoclonal antibodies may be an attractive alternative to daily oral antiretroviral treatment for children living with HIV. However, acceptability among caregivers remains unknown. Methods We evaluated monthly infusion of dual bNAbs (VRCO1LS and 10–1074) as a treatment alternative to ART among children participating in the Tatelo Study in Botswana. Eligible children aged 2–5 years received 8–32 weeks of bNAbs overlapping with ART, and up to 24 weeks of bNAbs alone as monthly intravenous infusion. Using closed-ended questionnaires, we evaluated caregiver acceptability of each treatment strategy prior to the first bNAb administration visit (pre-intervention) and after the completion of the final bNAb administration visit (post-intervention). Results Twenty-five children completed the intervention phase of the study, and acceptability data were available from 24 caregivers at both time points. Responses were provided by the child’s mother at both visits (60%), an extended family member at both visits (28%), or a combination of mother and an extended family member (12%). Caregiver acceptance of monthly bNAb infusions was extremely high both pre-and post-intervention, with 21/24 (87.5%) preferring bNAbs to ART pre-intervention, and 21/25 (84%) preferring bNAbs post-intervention. While no caregiver preferred ART pre-intervention, 2/25 preferred it post-intervention. Pre-intervention, 3 (13%) caregivers had no preference between monthly bNAbs or daily ART, and 2 (8%) had no preference post-intervention. Pre-intervention, the most common reasons for preferring bNAbs over ART were the perception that bNAbs were better at suppressing the virus than ART (n = 10) and the fact that infusions were dosed once monthly compared to daily ART (n = 9). Post-intervention, no dominant reason for preferring bNAbs over ART emerged from caregivers. Conclusions Monthly intravenous bNAb infusions were highly acceptable to caregivers of children with HIV in Botswana and preferred over standard ART by the majority of caregivers. Clinical Trial Number NCT03707977.

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“…This may be due to the increased pill burden, TB drugs interaction with protease inhibitors, while active TB can cause biologic effects of immune activation resulting in HIV viremia (27). ART adherence contributes to achievement of viral suppression thus EAC is recommended for PLHIV who have non-adherence issues or have detectable VL (11) (20) (28). Our findings showed about (44%) children had received EAC and were more likely to be non-suppressed.…”

Section: Discussionmentioning

confidence: 99%

“…Previously reported correlates of viral non-suppression among CYALHIV include being male, having had tuberculosis (TB), HIV status disclosure at an older age, experiencing ART adverse drug events, all of which have been associated with ART non-adherence (4)(9)(10). Some caregiver characteristics associated with viral non-suppression include one who isn’t the mother, caregiver substance abuse, poor socio economic status, inadequate social support (11) (12)(17). However, previous studies using routine programmatic data have been reported out of high HIV prevalence settings.…”

Section: Introductionmentioning

confidence: 99%

Viral load monitoring practices and correlates of viral non-suppression among children and young adolescents living with HIV in level five hospitals in Kiambu county, Kenya

Gachoka,

Njoroge

2024

Preprint

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BackgroundHIV has been a major global public health issue among children and young adolescents living with HIV (CYALHIV), their viral suppression rates being lower compared to adults. Follow up through viral load monitoring may influence their health outcomes.ObjectiveIn a cross-sectional study we determined viral load monitoring practices and correlates of viral non-suppression of all CYALHIV in three level five hospitals in Kiambu county, KenyaMethodsWe abstracted data from electronic and paper medical records. Multivariable log binomial regression was used to estimate prevalence ratios (PR) and assess correlates of non-suppression. Adherence to viral load testing guidelines was assessed. Viral non-suppression was defined as a VL >1000c/ml.ResultsOf the 252 CYALHIV, the median age was 11 (IQR: 7-13) years. Fourteen had non-suppression at last assessment. Correlates of non-suppression included having previously had TB [aPR=4.25; 95% CI=1.41-12.8; p=0.01], ART side effects [aPR=3.01; 95% CI=1.37-6.62 p=0.006] and having received enhanced adherence counselling [aPR =5.32; 95% CI=2.00-14.15; p=0.001]. Being on Dolutegravir was significantly associated with a lower likelihood of non-suppression (aPR=0.35; CI:0.15-0.85: p = 0.021). Timing of baseline VL tests improved through the years though there were gaps in routine VL monitoring and follow-up on unsuppressed results.ConclusionAt most current VL, 14% children were non-suppressed, higher than the 5% UNAIDS 2030 target. Special strategies on assessing and addressing corelates of non-suppression are essential for ART programs. Routine VL monitoring as per the guidelines was suboptimal despite increased access to VL testing, suggesting other barriers to VL monitoring.

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Assessing Adherence to Antiretroviral Therapy in a Rural Paediatric Cohort in KwaZulu-Natal, South Africa

Cited by 8 publications

References 34 publications

Adherence to antiretroviral treatment among children and adolescents in Tanzania: Comparison between pill count and viral load outcomes in a rural context of Mwanza region

Adherence to antiretroviral treatment among children and adolescents in Tanzania: Comparison between pill count and viral load outcomes in a rural context of Mwanza region

Caregivers of children with HIV in Botswana prefer monthly IV Broadly Neutralizing Antibodies (bNAbs) to daily oral ART

Viral load monitoring practices and correlates of viral non-suppression among children and young adolescents living with HIV in level five hospitals in Kiambu county, Kenya

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