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Liao R, Tang Z, Zhang N, Hu L, Chang Z, Ren J, Bai X, Shi J, Fan S, Pei R, Du L, Zhang T. Discrepancies between self-reported medication in adherence and indirect measurement adherence among patients undergoing antiretroviral therapy: a systematic review. Infect Dis Poverty 2024; 13:51. [PMID: 38970140 PMCID: PMC11225374 DOI: 10.1186/s40249-024-01221-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 06/24/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Given the critical importance of medication adherence in HIV/AIDS treatment, this study aims to compare medication adherence measured by self-report (SR) and indirect measurement among antiretroviral therapy (ART) patients, exploring the differences of adherence results measured by different tools. METHODS We systematically searched PubMed, Embase, and the Cochrane Library to identify all relevant literature published up to November 22, 2023, without language restrictions, reporting adherence to ART measured by both SR and indirect measurement methods, while also analyzing individual and group adherence separately. Discrepancies between SR and indirect measurement results were assessed using the Mann-Whitney U test or Wilcoxon signed-rank test, with correlations evaluated using the Pearson correlation coefficient. Following one-to-one comparisons, meta-epidemiological one-step analysis was conducted, and network meta-analysis techniques were applied to compare results obtained through specific adherence assessment tools reported in the identified articles. RESULTS The analysis encompassed 65 original studies involving 13,667 HIV/AIDS patients, leading to 112 one-to-one comparisons between SR and indirect measurement tools. Statistically significant differences were observed between SR and indirect measurement tools regarding both individual and group adherence (P < 0.05), with Pearson correlation coefficients of 0.843 for individual adherence and 0.684 for group adherence. During meta-epidemiological one-step analysis, SR-measured adherence was determined to be 3.94% (95% CI: -4.48-13.44%) higher for individual adherence and 16.14% (95% CI: 0.81-18.84%) higher for group adherence compared to indirectly measured results. Subgroup analysis indicated that factors such as the year of reporting and geographic region appeared to influence the discrepancies between SR and indirect measurements. Furthermore, network meta-analysis revealed that for both individual and group adherence, the results obtained from most SR and indirect measurement tools were higher than those from electronic monitoring devices, with some demonstrating statistical significance (P < 0.05). CONCLUSIONS The findings underscored the complexity of accurately measuring medication adherence among ART patients. Significant variability was observed across studies, with self-report methods showing a significant tendency towards overestimation. Year of reporting, geographic region, and adherence measurement tools appeared to influence the differences between SR and indirect measurements. Future research should focus on developing and validating integrated adherence measurements that can combine SR data with indirect measures to achieve a more comprehensive understanding of adherence behaviors.
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Affiliation(s)
- Rujun Liao
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zihuan Tang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Na Zhang
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Lin Hu
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zongqi Chang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jiayi Ren
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xuefei Bai
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinhong Shi
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Sisi Fan
- Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rong Pei
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, Sichuan, People's Republic of China
| | - Liang Du
- Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Tao Zhang
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
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Sliefert M, Maloba M, Wexler C, Were F, Mbithi Y, Mugendi G, Maliski E, Nicolay Z, Thomas G, Kale S, Maosa N, Finocchario-Kessler S. Challenges with pediatric antiretroviral therapy administration: Qualitative perspectives from caregivers and HIV providers in Kenya. PLoS One 2024; 19:e0296713. [PMID: 38194419 PMCID: PMC10775971 DOI: 10.1371/journal.pone.0296713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/15/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND Current formulations of pediatric antiretroviral therapy (ART) for children with HIV present significant barriers to adherence, leading to drug resistance, ART ineffectiveness, and preventable child morbidity and mortality. Understanding these challenges and how they contribute to suboptimal adherence is an important step in improving outcomes. This qualitative study describes how regimen-related challenges create barriers to adherence and impact families. METHODS We conducted key informant interviews (KIIs) with 30 healthcare providers and 9 focus group discussions (FGDs) with a total of 72 caregivers, across three public hospitals in Siaya and Mombasa Kenya. The KIIs and FGDs were audio recorded, translated, and transcribed verbatim. The transcripts were hand coded based on emergent and a-priori themes. RESULTS Caregivers discussed major regimen-related challenges to adherence included poor palatability of current formulations, complex preparation, and administration (including measuring, crushing, dissolving, mixing), complex drug storage, and frequent refill appointments and how these regimen-related challenges contributed to individual and intrapersonal barriers to adherence. Caregivers discussed how poor taste led to child anxiety, refusal of medications, and the need for caregivers to use bribes or threats during administration. Complex preparation led to concerns and challenges about maintaining privacy and confidentiality, especially during times of travel. Providers corroborated this patient experience and described how these challenges with administration led to poor infant outcomes, including high viral load and preventable morbidity. Providers discussed how the frequency of refills could range from every 2 weeks to every 3 months, depending on the patient. Caregivers discussed how these refill frequencies interrupted work and school schedules, risked unwanted disclosure to peers, required use of financial resources for travel, and ultimately were a challenge to adherence. CONCLUSION These findings highlight the need for improved formulations for pediatric ART to ease the daily burden on caregivers and children to increase adherence, improve child health, and overall quality of life of families.
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Affiliation(s)
- Michala Sliefert
- University of Kansas Medical Center, Kansas City, KS, United States of America
| | - May Maloba
- Global Health Innovations, Nairobi, Kenya
| | - Catherine Wexler
- University of Kansas Medical Center, Kansas City, KS, United States of America
| | | | | | | | - Edward Maliski
- Oak Therapeutics, Lawrence, KS, United States of America
| | | | - Gregory Thomas
- University of Kansas, Lawrence, KS, United States of America
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Gillette E, Nyandiko W, Baum A, Chory A, Aluoch J, Ashimosi C, Lidweye J, Njorge T, Sang F, Nyagaya J, Scanlon M, Vreeman R. Comparison of Self and Caregiver Reports of Antiretroviral Treatment Adherence among Children and Adolescents Living with HIV in Western Kenya. J Int Assoc Provid AIDS Care 2024; 23:23259582241242335. [PMID: 38562058 PMCID: PMC10989044 DOI: 10.1177/23259582241242335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/29/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Youth living with HIV with perinatal infection spend a lifetime taking antiretroviral treatment (ART) to suppress the virus, and face significant challenges to successfully maintaining ART adherence. Tools to measure adherence include self-report, medication event monitoring system (MEMS) pill bottle caps, pill counts, and plasma or hair drug levels; however, the inter-rater agreement between child and caregiver self-report has not been validated in an African setting. This study aims to assess inter-rater agreement between child and caregiver self-reports, compared to reporting from MEMS pill bottle caps. METHODS This was a secondary analysis of a cluster-randomized trial to evaluate an intervention for children living with HIV, conducted at the Academic Model Providing Access to Healthcare in western Kenya. We analyzed data from 285 child-caregiver dyads to compare adherence self-reported by children and their caregivers, and subsequently compared all self-reports to adherence reported by MEMS pill bottle caps to determine whether child or caregiver self-reports aligned more closely with adherence measured by MEMS. RESULTS Children and their caregivers reported similar levels of adherence and numbers of missed doses in the past month, and both reports were similarly associated with adherence reported by MEMS pill bottle caps. Children with a caregiver that was not a biological parent were significantly more likely to report more missed doses than their caregiver. The correlation coefficient for the relationship between the child and caregiver self-reports was 0.71; for the relationship between child report and MEMS was 0.23; and for the relationship between caregiver report and MEMS was 0.20. Both children and caregivers under-reported non-adherence compared to MEMS data. CONCLUSION Children and caregiver self-reports were generally similar in reporting adherence and were not highly correlated with MEMS reports of adherence, with children and caregivers reporting higher level of adherence than the MEMS data. This may indicate that children and caregiver reports are similarly inaccurate or biased; however, further research with larger sample sizes is required to further understand the differences in these reports.
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Affiliation(s)
- Emma Gillette
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Moi University College of Health Sciences, Eldoret, Kenya
| | - Aaron Baum
- Waymark Care, San Fransico, United States
| | - Ashley Chory
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njorge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Center for Global Health Equity, Indiana University, Indianapolis, Indiana, United States
| | - Rachel Vreeman
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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Lao X, Zhang H, Yan L, Zhao H, Zhao Q, Lu H, Chen Y, Li H, Chen J, Ye F, Yu F, Xiao Q, Li Q, Liang X, Yang X, Yan C, Zhang F. Thirteen-year viral suppression and immunologic recovery of LPV/r-based regimens in pediatric HIV treatment: a multicenter cohort study in resource-constrained settings of China. Front Med (Lausanne) 2023; 10:1313734. [PMID: 38188331 PMCID: PMC10771832 DOI: 10.3389/fmed.2023.1313734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/07/2023] [Indexed: 01/09/2024] Open
Abstract
Background Antiretroviral Therapy (ART) in children remains challenging due to resource-constrained settings. We conducted a 13-year, prospective, multicenter cohort study on the effectiveness and safety of LPV/r-based regimens in ART-naive and ART-experienced children. Methods From January 2008 to May 2021, children living with HIV-1 were recruited with LPV/r-based regimens from 8 clinical research sites in 6 provinces in China. Effectiveness outcomes were virologic failure (defined as at least two consecutive measurements of VL > 200 copies/mL after 6 months of ART) and immune response (defined as CD4% recovered to more than 25% after 12 months of treatment). The safety outcomes were treatment-related grade 2-4 adverse events and abnormal laboratory test results. Results A total of 345 ART-naïve children and 113 ART-experienced children were included in this cohort study. The median follow-up time was 7.3 (IQR 5.5-10.5) years. The incidence density of virologic failure was 4.1 (95% CI 3.3-4.9) per 100 person-years in ART-naïve children and 5.0 (95% CI 3.5-6.5) per 100 person-years in ART-experienced children. Kaplan Meyer (KM) curve analysis showed children with ART experience were at a higher risk of virologic failure (p < 0.05). The risk factors of virologic failure in ART-naïve children were clinic setting in rural hospitals (aHR = 2.251, 1.108-4.575), annual missed dose times >5 days of LPV intake (aHR = 1.889, 1.004-3.554); The risk factor of virologic failure in ART-experienced children was missed dose times >5 days (aHR = 2.689, 1.299-5.604) and mother as caregivers for ART administration (aHR = 0.475, 0.238-0.948). However, during long-term treatment, viral suppression rates between ART-naïve and ART-experienced children remained similar. No significant differences were observed in the immune response, treatment-related grade 2-4 events, and abnormal laboratory test results between ART-naïve children and ART-experienced children. Conclusion Our research underscores that with consistent, long-term treatment of LPV/r-based regimens, ART-experienced children can achieve therapeutic outcomes comparable to ART-naïve children. It provides crucial insights on LPV/r-based regimens in pediatric HIV treatment, especially in resource-limited settings where high-cost Integrase Strand Transfer Inhibitors (INSTs) are inaccessible. This evidence-based understanding provides an essential addition to the global therapeutic strategies for pediatric HIV treatment.
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Affiliation(s)
- Xiaojie Lao
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Hanxi Zhang
- WHO Collaborating Centre for Comprehensive Management of HIV Treatment and Care, Beijing Ditan Hospital Capital Medical University, Beijing, China
| | - Liting Yan
- Department of Infectious Disease, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongxin Zhao
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qingxia Zhao
- Department of Infectious Disease, The Sixth People's Hospital of Zhengzhou, Zhengzhou, China
| | - Hongyan Lu
- Department of Infectious Disease, Guangxi Zhuang Autonomous Region Center for Disease Control and Prevention, Nanning, China
| | - Yuewu Chen
- Department of Infectious Disease, Shangcai Center for Disease Control and Prevention of Henan Province, Shangcai, China
| | - Huiqin Li
- AIDS Care Center, Yunnan Provincial Hospital of Infectious Disease, Kunming, China
| | - Jinfeng Chen
- Center for Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Fuxiu Ye
- Department of Infectious Disease, The Second People's Hospital of Yining, Xinjiang, China
| | - Fengting Yu
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qing Xiao
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Qun Li
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xuelei Liang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Xiaojie Yang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Chang Yan
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Fujie Zhang
- Department of Infectious Disease, Beijing Ditan Hospital, Capital Medical University, Beijing, China
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Scorgie F, Hawley I, Fairlie L, Pahad S, Mathebula F, Mohuba R, London SJ, Cottrell ML, Johnson LM, Montgomery ET. Acceptability of Implants for HIV Treatment in Young Children: Perspectives of Health Care Providers in Johannesburg, South Africa. AIDS Patient Care STDS 2022; 36:389-395. [PMID: 36286579 PMCID: PMC9595609 DOI: 10.1089/apc.2022.0087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
In South Africa, less than half of children receiving antiretroviral therapy are virally suppressed. Adherence challenges include poor palatability of drugs and high pill burden. Subcutaneous implants offer a long-acting alternative to daily oral dosing regimens, which may improve outcomes in children living with HIV (CLWH). Qualitative in-depth interviews were conducted with 24 health care providers (HCPs) in Johannesburg, South Africa. Interviews were audio-recorded and transcribed. Data were coded and analyzed using NVivo 12 software and a Grounded Theory approach. Most HCPs welcomed an implant option for CLWH. Perceived benefits included fewer clinic visits, improved adherence, and "normalization" of the lives of CLWH. Concerns included painful insertion and removal, the potential for stigmatization, and caregivers' likely rejection of biodegradable implants. A single, small, non-transparent rod with some flexibility was preferred by most participants. HCP training and early outreach to mitigate potential misinformation about implants and caregivers' fears about biodegradable implants were emphasized. Further engagement with caregivers of CLWH is required and ongoing.
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Affiliation(s)
- Fiona Scorgie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Imogen Hawley
- Women's Global Health Imperative, RTI International, Berkeley, California, USA
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shenaaz Pahad
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Florence Mathebula
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rebone Mohuba
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sarah-Jane London
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Leah M. Johnson
- RTI International, Research Triangle Park, North Carolina, USA
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Katusiime MG, Van Zyl GU, Cotton MF, Kearney MF. HIV-1 Persistence in Children during Suppressive ART. Viruses 2021; 13:v13061134. [PMID: 34204740 PMCID: PMC8231535 DOI: 10.3390/v13061134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 06/06/2021] [Accepted: 06/08/2021] [Indexed: 12/16/2022] Open
Abstract
There is a growing number of perinatally HIV-1-infected children worldwide who must maintain life-long ART. In early life, HIV-1 infection is established in an immunologically inexperienced environment in which maternal ART and immune dynamics during pregnancy play a role in reservoir establishment. Children that initiated early antiretroviral therapy (ART) and maintained long-term suppression of viremia have smaller and less diverse HIV reservoirs than adults, although their proviral landscape during ART is reported to be similar to that of adults. The ability of these early infected cells to persist long-term through clonal expansion poses a major barrier to finding a cure. Furthermore, the effects of life-long HIV persistence and ART are yet to be understood, but growing evidence suggests that these individuals are at an increased risk for developing non-AIDS-related comorbidities, which underscores the need for an HIV cure.
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Affiliation(s)
- Mary Grace Katusiime
- HIV Dynamics and Replication Program, CCR, National Cancer Institute, Frederick, MD 21702, USA;
- Correspondence:
| | - Gert U. Van Zyl
- Division of Medical Virology, Stellenbosch University and National Health Laboratory Service Tygerberg, Cape Town 8000, South Africa;
| | - Mark F. Cotton
- Department of Pediatrics and Child Health, Tygerberg Children’s Hospital and Family Center for Research with Ubuntu, Stellenbosch University, Cape Town 7505, South Africa;
| | - Mary F. Kearney
- HIV Dynamics and Replication Program, CCR, National Cancer Institute, Frederick, MD 21702, USA;
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7
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Ter Haar AM, Van den Hof M, Scherpbier HJ, Oostrom KJ, Haverman L, Pajkrt D. Health-related quality of life of perinatally HIV-infected young people: a longitudinal study. AIDS Care 2021; 34:263-271. [PMID: 33793369 DOI: 10.1080/09540121.2021.1909695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Young people perinatally infected with HIV (pHIV) are at risk of a lowered health-related quality of life (HRQOL). Previous evaluation of the NeurOlogical, VIsual and Cognitive performance in HIV-infected Children (NOVICE)-cohort showed no difference in HRQOL between pHIV and matched HIV-uninfected controls (HIV-), yet a higher percentage of pHIV had impaired HRQOL. The aim of this study is to compare the change over time in HRQOL of pHIV to HIV- over a 5-year period. We used the Pediatric Quality of Life Inventory (PedsQL)™ 4.0 to repeat HRQOL assessment. High PedsQL scores indicate good HRQOL. Fifteen/33 (45.5%) pHIV and 17/37 (45.9%) HIV- completed both assessments. At the first assessment, the mean age was 13.1 years (range 8.0-18.4). PHIV scored higher than HIV- on Emotional functioning and on Total scale score. After five years, the mean age was 17.6 years (range 12.1-22.8). PHIV scored higher than HIV- on all scales, except Social functioning. PHIV did not differ significantly from the Dutch norm on either time-point. LMEM showed no difference in change over time for any of the PedsQL scales. In this study, young people with pHIV receiving high-quality health care, including monitoring of HRQOL, remain to experience a good HRQOL.
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Affiliation(s)
- A M Ter Haar
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
| | - M Van den Hof
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
| | - H J Scherpbier
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
| | - K J Oostrom
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, Department of Child and Adolescent Psychiatry, Pediatric Psychology and Psychosocial Care, University of Amsterdam, Amsterdam, Netherlands
| | - L Haverman
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, Department of Child and Adolescent Psychiatry, Pediatric Psychology and Psychosocial Care, University of Amsterdam, Amsterdam, Netherlands
| | - D Pajkrt
- Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Pediatric Infectious Diseases, Amsterdam, Netherlands
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van Elsland SL, Peters RPH, Grobbelaar C, Ketelo P, Kok MO, Cotton MF, van Furth AM. Disclosure of human immunodeficiency virus status to children in South Africa: A comprehensive analysis. South Afr J HIV Med 2019; 20:884. [PMID: 31534786 PMCID: PMC6739545 DOI: 10.4102/sajhivmed.v20i1.884] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/05/2019] [Indexed: 11/28/2022] Open
Abstract
Background The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older age of the child and higher education of the caregiver were strongly associated with disclosure. Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens with stavudine and didanosine, and self-reported non-adherence were strongly associated with non-disclosure. Conclusion When children do well on treatment, caregivers feel less stringent need to disclose. Well-functioning families, higher educated caregivers and better socio-economic status enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure which could negatively affect adherence and viral suppression. There is an urgent need to address disclosure thoughtfully and proactively in the long-term disease management. For the disclosure process to be beneficial, an enabling supportive context is important, which will provide a great opportunity for future interventions.
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Affiliation(s)
- Sabine L van Elsland
- Department of Paediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Department of Paediatrics and Child Health, Tygerberg Children's Hospital, Stellenbosch University, Cape Town, South Africa
| | | | | | | | - Maarten O Kok
- Department of Health Care Governance, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Nertherlands
| | - Mark F Cotton
- FAM-CRU, Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - A Marceline van Furth
- Department of Paediatric Infectious Diseases and Immunology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
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9
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van Elsland SL, Peters RPH, Kok MO, van Toorn R, Springer P, Cotton MF, Grobbelaar CJ, Aarnoutse R, van Furth AM. A treatment-support intervention evaluated in South African paediatric populations with HIV infection or tuberculous meningitis. Trop Med Int Health 2018; 23:1129-1140. [PMID: 30075490 DOI: 10.1111/tmi.13134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To evaluate a paediatric treatment-support intervention for home-based treatment of HIV infection or tuberculous meningitis (TBM). METHODS A randomised-controlled study comparing local standard care (controls) with standard care plus intervention (combining adherence education, reinforcement and monitoring) in children aged 0-14 years. We recorded adherence measures (self-report, pill-count, drug-assays for isoniazid and rifampicin in urine and pyrazinamide in saliva), difficulties administering medication and PedsQL™questionnaires for health-related quality-of-life (HRQoL) and family impact. RESULTS In the HIV group (6-months follow-up, n = 195), more children had above-median HRQoL-scores in the intervention group than in the control group (P = 0.009). Problems reported administering medication declined between baseline and follow-up for controls (P = 0.043). Disclosure of HIV status to the child increased between baseline and follow-up in both groups (intervention P < 0.001; control P = 0.031). In the TBM group (3-months follow-up, n = 43), all adherence measures remained high for both intervention and controls, except for rifampicin which declined between baseline and follow-up in the intervention group (P = 0.031). The intervention group maintained above median HRQoL-scores between baseline and follow-up, when the number of children with above-median HRQoL-scores decreased in the controls (P = 0.063). More children in the intervention group had above-median family impact-scores than controls (P = 0.040). CONCLUSIONS The low-cost, culturally friendly treatment-support intervention had beneficial effects on health-related quality of life, family impact, caregiver disclosure of HIV status to the child, increased caregiver reporting of medication non-adherence and caregiver reporting of difficulties administering medication. Treatment adherence was not significantly affected in either HIV or TBM group.
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Affiliation(s)
- Sabine L van Elsland
- Department of Pediatric Infectious Diseases and Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | | | - Maarten O Kok
- Department of Health Care Governance, Erasmus School of Health Policy and Management at Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Ronald van Toorn
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Priscilla Springer
- Department of Paediatrics and Child Health, Tygerberg Hospital, Stellenbosch University, Stellenbosch, South Africa
| | - Mark F Cotton
- Tygerberg Hospital, KIDS-CRU Stellenbosch University, Cape Town, South Africa
| | | | - Rob Aarnoutse
- Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Marceline van Furth
- Department of Pediatric Infectious Diseases and Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
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