Excellent Adherence to Antiretrovirals in HIV+ Zambian Children Is Compromised by Disrupted Routine, HIV Nondisclosure, and Paradoxical Income Effects

Abstract

IntroductionA better understanding of pediatric antiretroviral therapy (ART) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence.Methodology/Principal FindingsAdherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9) initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26) with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS). HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4%) by visual analog scale, 94.8% (IQR 86,100%) by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2%) by clinic pill count, 93.4% (IQR 90.2,96.7%) by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7%) by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013). Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income.Conclusions/SignificanceAdherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.

Factors Affecting Adherence to Pediatrics Antiretroviral Therapy in Mekelle Hospital, Tigray Ethiopia

“…Male sex care givers favors adherence which is similar with the finding in the United States of America and Nigeria [16], [19]. In contrast to this study, in Zambia female patients were adherent than males [21].…”

Adherence to the Treatment of Children Living with HIV: A Conceptual Analysis

“…Em corroboração a tais aspectos, o maior problema em crianças com infecção pelo HIV é o fato delas dependerem dos pais ou cuidadores para receberem seus medicamentos e do comportamento da própria criança em acatar as recomendações advindas da equipe de saúde (6,10,21).…”

“…Ao entender a infecção pelo HIV, ela passa a dar sentido à doença, relacionando-a com suas próprias experiências e à importância da necessidade de seguir a terapia preconizada (9,10,22,23,31).…”

“…Como evidenciado, a ingestão correta de medicamentos prescritos e a adequada aderência da criança aos cuidados prescritos têm se mostrado efetivas para a redução da replicação do vírus HIV, suprimindo os níveis de carga viral e consequentemente levando à restauração imune (10,19,22). A melhoria do estado imunitário é clinicamente visível pela diminuição significativa de episódios de adoecimento (25).…”

“…Tal processo requer melhor elucidação. No entanto, conforme aponta a literatura (6,8,9,10), apesar da grande população pediátrica com HIV, a investigação em cuidados e tratamento neste cenário ainda é limitada, principalmente em face do pequeno recorte temporal da epidemia envolvendo crianças. São escassos os estudos sobre essa temática e os existentes foram conduzidos em países desenvolvidos.…”