Multi-measure assessment of adherence to antiretroviral therapy among children under five years living with HIV in Jinja, Uganda

Abstract

Background: Adherence to Antiretroviral Therapy (ART) is required to achieve HIV viral load suppression. However, children under 5 years in Jinja, Uganda, had been shown to have low HIV suppression rates. This study aimed to determine the level of ART non-adherence among these children and the associated factors. Methods: Data for the cross-sectional study was collected from April to July 2019, from caregivers of 206 children under 5 years living with HIV who were attending health facilities in Jinja and had been on ART for at least 3 months. Non-adherence was measured using a Visual Analog Scale that assessed both dosing and timing nonadherence, and by determining the Proportion of Days Covered by the medication. A questionnaire administered to the caregivers was used to collect the data, together with medical record review. A child was only considered adherent if they had adherence greater than 95% on all the measures. The data was analysed using Modified Poisson Regression, taking a p-value less than 0.05 as statistically significant. Results: Of the 206 children, 73.8% were older than 2 years, and 52.9% were female. Likewise, the majority of caregivers were female (93.7%). Using the combined adherence measure, 57.3% of the children were categorised as non-adherent. School/day-care attendance, Prevalence Ratio (PR) = 1.25 (p = 0.042), the caregiver having higher than a primary school education, PR = 0.72 (p = 0.044) and satisfaction with the quality of service at the health facility, PR = 0.97 (p < 0.001) were associated with non-adherence. Household food insecurity was also associated with nonadherence: PR = 1.55 (p = 0.011) for mild food insecurity, PR = 1.75 (p = 0.001) for moderate insecurity and PR = 1.48 (p = 0.015) for severe food insecurity. Conclusions: Children under 5 years in Jinja had a high level of ART non-adherence. It is important to engage schools to support adherence among children living with HIV. Addressing household food insecurity and improving the quality of paediatric ART services would also reduce the barriers to optimal adherence.

Adherence to Antiretroviral Therapy and Associated Factors Among Children Living With HIV in East Wallaga Zone Public Health Institutions, Ethiopia

“…14 However, it was less than different researches done in Ethiopia which were 90% to 94%, 10-12 91% in Nigeria, 8 and 89.1% in South Africa. 7 However, the current study was higher than studies conducted in Fiche, Ethiopia which was 64.2%, 9 66.7% in Ambo (Ethiopia), 15 79.8% in South Sudan, 4 42.7% in Uganda, 16 and 47.5% in Ghana. 6 The discrepancies might be due to differences in the measurement of adherence assessment used and differences in clinical settings.…”

Food and water insecurity in households of children and adolescents living with HIV and receiving care in a rural Zambian hospital: A mixed-methods study

“…Numerous observational studies in adults support a link between food insecurity and poor treatment adherence [ 28 ], including work carried out in Zambia [ 29 ]. More recent research has suggested that children may likewise be affected [ 30 , 31 ]. In our study, we found no significant differences in antiretroviral therapy adherence among children in food insecure households.…”

Comparison of Self and Caregiver Reports of Antiretroviral Treatment Adherence among Children and Adolescents Living with HIV in Western Kenya

“…Previous work in Uganda, Kenya, South Africa, Thailand, and the Netherlands have used various combinations of caregiver self-reports of missed doses, electronic dose monitoring, pill counts, and plasma or hair drug levels to measure and report on ART adherence. 5 , 13 – 15 Due to the high cost associated with its’ use, electronic dose monitoring is not feasible in every setting; however, it is considered to be a reliable measurement of medication adherence. 16 Medication event monitoring systems (MEMS ® ; Aardex Group Ltd., Seraign, Belgium, Switzerland) 17 pill bottle caps are commonly used for this purpose and record a time stamp of each time the pill bottle is opened in order report on how many doses are taken in a time period.…”

“…A more feasible and low-cost measurement of adherence is child and caregiver self-reports, as they don’t require any additional equipment, blood draws or for YLWH to bring medication into clinic. 13 , 14 , 18 – 20 Self-reports, however, introduce a risk of social desirability bias, in which individuals may over-report the number of doses taken out of a fear of reporting undesirable outcomes to researchers and clinicians. 21 While social desirability bias is somewhat intractable in research and clinical assessment, it may be mitigated by establishing trust and rapport with researchers or clinicians or using particular language in surveys and questionnaires, which may increase the validity of self-reports.…”