Effect of Caregivers' Depression and Alcohol Use on Child Antiretroviral Adherence in South Africa

Abstract

Pediatric antiretroviral adherence is difficult to assess, and subjective measures are affected by reporting bias, which in turn may depend on psychosocial factors such as alcohol use and depression. We enrolled 56 childcaregiver dyads from Cape Town, South Africa and followed their adherence over 1 month via various methods. The Alcohol Use Disorder Inventory Tool and Beck Depression Inventory 1 were used to assess these factors and their affect on pediatric adherence. The median age of the children was 4 years, and median time on antiretrovirals was 20 months. Increased time on ART was associated with poorer adherence via 3-day recall (3DR; p = 0.03). Ethanol use was inversely associated with adherence by both subjective measures, 3DR and visual analogue scale (VAS) (both p < 0.01), and with Medication Event Monitoring System (MEMS) adherence as a continuous variable. In a multivariate analysis predicting MEMS adherence greater than 95%, including variables that were associated with adherence in univariate analyses, having a mother as a caregiver and shorter time on highly active antiretroviral therapy (HAART) were significantly associated with adherence (odds ratio [OR] 19.2; 95% confidence interval [CI] 1.1-327 and 0.9; 95% CI 0.9-0.99). Pediatric adherence is affected by caregiver alcohol use, but caregiver relationship to the child is most important. This small study suggests that interventions should aim to keep mothers healthy and alive, as well as alcohol-free.

Predictors of loss to follow-up among children in the first and second years of antiretroviral treatment in Johannesburg, South Africa

“…A recent study of paediatric ART adherence in Gugulethu, Cape Town, showed that children cared for by their mothers were more adherent than those cared for by other relatives or foster parents, contradictory findings to those in our study (24). …”

Prevalence and correlates of depression among caregivers of children living with HIV in Ghana: findings from the Sankofa pediatric disclosure study

“…Third, the study is a cross-sectional study so we cannot determine the causality or temporal order of caregiving and depression. Fourth, although the BDI has been validated for use in sub-Saharan Africa (Abubakar et al, 2016;Jaspan et al, 2011), and the prevalence of depression detected by the BDI is similar to that identified with other standardized measures (Kuo & Operario, 2011;, there could be cultural differences (M. H. Kim et al, 2014). Interestingly, there are reports that in sub-Saharan Africa, the BDI may be more sensitive than the other instruments used for measuring depression (M. H. Kim et al, 2014).…”

“…In sub-Saharan Africa, most of the studies on caregiver depression are from high HIV-endemic communities in South Africa. Jaspan et al, using the BDI for measuring depression, reported a rate of 33% among caregivers of HIV-infected children in Cape Town, South Africa (Jaspan, Mueller, Myer, Bekker, & Orrell, 2011). Kuo et al reported that depression among caregivers of HIVinfected children in the KwaZulu Natal province, South Africa, ranged from 27.9% to 35.2% (Kuo & Operario, 2011).…”

Evaluation of Parent-Child Pairs on Antiretroviral Therapy in Separate Adult and Pediatric Clinics

“…Adherence has been related to behavioral issues in the caregiver, such as depression and alcohol use, as well as to life stresses in women, such as child care burden and the number of children in a household younger than 18 years of age. 10,11,15 Communication is important when separate clinics are utilized for adults and children on ART, which is emphasized by the narrative concerning TB and parent withdrawal from ART. Asking questions about the progress of the other member of the pair at every visit and requesting to see self-retained medical records can ameliorate much of this potential problem.…”