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Tesfahunegn TB, Berhe N, Abraha TH, Hintsa S, Yohanes G, Desta K, Alema HB, Hagos E, Gidey G, Teshahunegn GB. Adherence to Antiretroviral Therapy and Associated Factors Among HIV-Infected Children in Public Health Institutions of Adwa, Axum, and Shire Towns of Tigray, Northern Ethiopia: A Cross-Sectional Study. HIV AIDS (Auckl) 2023; 15:217-224. [PMID: 37163177 PMCID: PMC10164383 DOI: 10.2147/hiv.s282938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 06/28/2021] [Indexed: 05/11/2023] Open
Abstract
Background Antiretroviral therapy (ART) provision was among the major challenge of treatments. Maintaining the optimal level of adherence among children living with HIV/AIDS is a pivotal step towards achieving treatment success. However, there are limited studies on child's ART adherence. Therefore, this study aimed to assess the level of adherence to antiretroviral therapy and associated factors among HIV-infected children in health institutions of Adwa, Axum, and Shire towns, Tigray, Northern Ethiopia. Methods An institutional-based cross-sectional study was conducted among human immunodeficiency virus (HIV)-infected children in between February and April, 2016. A total of 255 children who were taking antiretroviral therapy in the randomly selected three health facilities from Adwa, Axum and Shire towns were included. Data were collected using pretested and structured questionnaires using a face-to-face interview. The collected data were entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. Bivariate and multivariate binary logistic regression models were used to determine the factors associated with adherence to antiretroviral therapy among HIV-infected children. Results A total of the 255 study participants were included in the study. The level of ART adherence among HIV-positive children was 212 (84.8%). Knowledge of caregivers about ART treatment (AOR = 2.78, 95% CI: 1.18, 6.53), occupational status (AOR = 4.78, 95% CI: 1.26, 18.91), appointment to ART less than two months (AOR = 3.05, 95% CI: 1.21, 7.70) and use of memory aids (AOR = 4.58, 95% CI: 1.73, 12.13) were independently associated with adherence to ART. Conclusion The level of adherence to antiretroviral therapy was low. Healthcare providers should reinforce adherence intervention and counseling sessions during follow-up and address the proper use of medication reminders to help children take their drugs appropriately.
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Affiliation(s)
- Tadis Brhane Tesfahunegn
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Negassie Berhe
- Department of Human Nutrition, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | | | - Solomon Hintsa
- Department of Epidemiology, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Goitom Yohanes
- Department of Reproductive Health, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Kahsay Desta
- School of Medicine, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | | | - Elsa Hagos
- Department of Medical Laboratory, College of Health Sciences, Aksum University, Aksum, Ethiopia
| | - Gebreamlak Gidey
- Department of Midwifery, College of Health Sciences, Aksum University, Aksum, Ethiopia
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Okonji EF, van Wyk B, Hughes GD, Mukumbang FC. Psychosocial Support Programme Improves Adherence and Health Systems Experiences for Adolescents on Antiretroviral Therapy in Mpumalanga Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15468. [PMID: 36497544 PMCID: PMC9739873 DOI: 10.3390/ijerph192315468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/09/2022] [Accepted: 11/19/2022] [Indexed: 06/17/2023]
Abstract
(1) Background: Psychosocial support (PSS) plays a significant role in persistent adherence to and retention in antiretroviral therapy (ART) for adolescents living with the human immunodeficiency virus (ALHIV). This paper qualitatively explores the experiences of ALHIV on ART, who participated in a PSS programme in five public primary healthcare facilities in Mpumalanga Province in South Africa during the COVID-19 pandemic. (2) Methods: Data were collected through 24 focus group discussions with 173 ALHIV on ART and subjected to inductive thematic analysis. Informed consent was obtained before all data collection. (3) Results: The PSS programme facilitated the process of full HIV disclosure to these adolescents with the support of parents/guardians while motivating adherence through peer support groups and health education for improved treatment literacy. Participants reported positive health systems experiences, improved healthcare provider-client relations, and prompt access to health services. (4) Conclusions: The PSS programme successfully kept ALHIV engaged in ART care despite the health service disruptions encountered during the COVID-19 pandemic. We recommend rigorous evaluation of the effects of the PSS intervention on adherence to and retention in ART among ALHIV in HIV-endemic settings.
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Affiliation(s)
- Emeka Francis Okonji
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
| | - Gail D. Hughes
- Medical Biosciences Department, University of the Western Cape, Cape Town 7535, South Africa
| | - Ferdinand C. Mukumbang
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
- Department of Global Health, University of Washington, Seattle, WA 98195, USA
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Mussa FM, Massawe HP, Bhalloo H, Moledina S, Assenga E. Magnitude and associated factors of anti-retroviral therapy adherence among children attending HIV care and treatment clinics in Dar es Salaam, Tanzania. PLoS One 2022; 17:e0275420. [PMID: 36178915 PMCID: PMC9524636 DOI: 10.1371/journal.pone.0275420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/17/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The HIV pandemic continues to contribute significantly towards childhood mortality and morbidity. The up-scaling of the Anti-retroviral therapy (ART) access has seen more children surviving and sanctions great effort be made on ensuring adherence. Adherence is a dynamic process that changes over time and is determined by variable factors. This necessitates the urgency to conduct studies to determine the potential factors affecting adherence in our setting and therefore achieve the 90-90-90 goal of sustainable viral suppression. Objectives To assess the magnitude and associated factors of ART adherence among children (1–14 years) attending HIV care and treatment clinics during the months of July to November 2018 in Dar es Salaam. Methods A cross-sectional clinic-based study, conducted in three selected HIV care and treatment clinics in urban Dar es Salaam; Muhimbili National Hospital (MNH), Temeke Regional Referral Hospital (TRRH), Infectious Disease Centre- DarDar Paediatric Program (IDC-DPP) HIV clinics during the months of July to November 2018. HIV-infected children aged 1–14 years who had been on treatment for at least six months were consecutively enrolled until the sample size was achieved. A structured questionnaire was used for data collection. Four-day self-report, one-month self-recall report and missed clinic appointments were used to assess adherence. Frequencies and percentages were used to describe categorical data. The odds ratio was used to analyse the possible factors affecting ART adherence Logistic regression models were used to determine the factors associated with ART adherence. Analysis was conducted using SPSS version 20.0 and p-value <0.05 were considered statistically significant. Results 333 participants were recruited. The overall good adherence (≥95%) was approximated to be 60% (CI-54.3–65.1) when subjected to all three measures. On multivariable logistic regression, factors associated with higher odds of poor adherence were found to be caregivers aged 17–25 years [AOR = 3.5, 95%CI-(1.5–8.4)], children having an inter-current illness [AOR = 10.8, 95%CI-(2.3–50.4)], disbelief in ART effectiveness [AOR = 5.495; 95%CI-(1.669–18.182)] and advanced clinical stage [AOR = 1.972; 95% CI-(1.119–3.484)]. The major reasons reported by caregivers for missing medications included forgetfulness (41%), high pill burden (21%), busy schedule (11%) and long waiting hours at the clinic (9%). Conclusion and recommendations In the urban setting of Dar es Salaam, ART adherence among children was found to be relatively low when combined adherence measures were used. Factors associated with poor ART adherence found were younger aged caregivers, and child intercurrent illness, while factors conferring good adherence were belief in ART effectiveness and lower HIV clinical stage. More attention and support should be given to younger aged caregivers, children with concomitant illness and advanced HIV clinical stages. Educating caregivers on ART effectiveness may also aid in improving adherence.
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Affiliation(s)
- Fatima M. Mussa
- Department of Paediatrics and Child Health, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Higgins P. Massawe
- Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Sibtain Moledina
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health Sciences, Dar es Salaam, Tanzania
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Tiruneh CM, Emiru TD, Tibebu NS, Abate MW, Nigat AB, Bantie B, Belete A, Walle BG, Legas G, Getu BD. Clinical Non-Adherence and Its Associated Factors Among HIV-Positive Pediatric Patients Attending HIV Care in South Gondar Zone Public Health Facilities, Northwest Ethiopia, 2021. HIV AIDS (Auckl) 2022; 14:23-32. [PMID: 35125892 PMCID: PMC8809518 DOI: 10.2147/hiv.s352386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Poor clinical adherence is the main factor that hinders ART adherence level in children and its ultimate effect on viral load suppression and decreasing morbidity and mortality of children. Although data from different settings are necessary to tackle such types of problems, the pieces of evidence are limited in the case of clinical adherence level. Therefore, this study was intended to assess clinical non-adherence and its associated factors among HIV-infected pediatrics on highly active antiretroviral therapy. Methods A multi-center cross-sectional study was conducted from July 1 to August 30, 2021, among HIV-infected children receiving ART in the South Gondar Zone. Data were collected through face-to-face interviews, and reviewing patients’ documents using a structured checklist. Data were entered into Epi-data version 4.6 and exported to the Statistical Package for Social Science version 23 for analysis. Binary logistic regression was used to assess the association between the factors and the outcome variable. The significance of variables was declared when a p-value was less than 0.05. Results From 422 participants, 383 have involved in the study making the response rate of 90.7%. Almost half of the study participants 190 (49.6%) were girls. Two hundred ninety-one (76%) of caretakers were biological mothers, and 203 (53%) did not have adherence supporters. About 179 (46.7%) of caretakers did not disclose the status of the child about the illness. The overall prevalence of non-adherence among children on ART was 31.9% (95% CI: 27.2–36.6). Rural residency, diagnostic status non-disclosure, no adherence supporter, having no biological caretaker and co-morbid illness were significantly associated with clinical non-adherence of HIV positive children. Conclusion Clinical non-adherence among children among HIV-positive children attending care in south Gondar zone health facilities is unacceptably high. Attention shall be given to HIV-positive pediatrics who reside in rural areas, whose status was not disclosed, had no adherence supporter, had a non-biological caretaker, and had comorbidity to have good clinical adherence on ART service.
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Affiliation(s)
- Chalie Marew Tiruneh
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Correspondence: Chalie Marew Tiruneh, Email ; Tigabu Desie Emiru, Email
| | - Tigabu Desie Emiru
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Nigusie Selomon Tibebu
- Department of Pediatrics and Child Health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Moges Wubneh Abate
- Department of Adult Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Adane Birhanu Nigat
- Department of Adult Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Adult Health Nursing, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amsalu Belete
- Department of Psychiatry, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Belete Gelaw Walle
- Department of Pediatrics and Child Health Nursing, College of Health Science and Medicine, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Getasew Legas
- Department of Psychiatry, College of Health Sciences, School of Medicine, Debre Tabor University, Debre Tabor, Ethiopia
| | - Bisrat Dessie Getu
- Department of Nursing, Debre Tabor Health Sciences College, Debre Tabor, Ethiopia
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GebreEyesus F, Mitku D, Tarekegn T, Temere B, Terefe T, Belete A, Legas G, Feleke D, Taye MG, Baye N, Admasu F, Dagnew E, Liyeh T, Jimma M, Chanie E. Levels of Adherence and Associated Factors Among Children on ART Over Time in Northwest, Ethiopia: Evidence from a Multicenter Follow-Up Study. HIV AIDS (Auckl) 2021; 13:829-838. [PMID: 34434060 PMCID: PMC8380805 DOI: 10.2147/hiv.s323090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/01/2021] [Indexed: 11/25/2022] Open
Abstract
Background Despite the increased availability of antiretroviral therapy (ART), its success depends on a high level of adherence to a life-long antiretroviral therapy. However, the extent and factors associated with adherence to ART are not well known, especially in the current study setup. Therefore, this study aimed to assess the level of adherence and associated factors among children on ART in Northwest, Ethiopia. Methods A retrospective follow-up study was conducted on human immunodeficiency virus (HIV)-infected children receiving ART at South Gondar public hospitals. Children receiving ART from January 1, 2015, to November 30, 2020, were included in the study. A computer-generated simple random sampling technique was employed. The data were entered into the EpiData version 3.1 and analyzed by STATA 14 statistical software. Bivariable logistic regression was fitted for each predictor variable. Moreover, those variables having a p-value ≤0.25 in bivariate analysis were fitted into a multivariable logistic regression model. P-value <0.05 was used to declare significance. Results A total of 363 HIV-infected children were involved in the study. From 363 HIV-infected children, the level of adherence to ART was found to be 78.2%, 95% CI (73.6, 82.2). TB co-infection [adjusted odds ratio (AOR) = 3.8, 95% CI (1.41, 10.1)], short duration on ART (AOR = 3.4, 95% CI (1.60, 7.20)), treatment failure (AOR = 10.2, 95% CI (3.95, 26.2)), and Zidovudine containing ART regimen (AOR = 3.5, 95% CI (1.1, 10.9)) were significant predictors of poor adherence. Conclusion The current study showed that the level of adherence to ART was found to be low TB co-infection, short duration of ART, Zidovudine-containing ART regimen, and treatment failure were found to be significantly associated with poor adherence. Further studies on adherence rate and its determinants with multiple adherence measurements using prospective and multicenter studies were recommended.
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Affiliation(s)
- Fisha GebreEyesus
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
- Correspondence: Fisha GebreEyesus Email
| | | | - Tadesse Tarekegn
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Bogale Temere
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | - Tamene Terefe
- Department of Nursing, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia
| | | | | | | | | | - Nega Baye
- DebreTabor University, DebreTabor, Ethiopia
| | | | | | | | - Melkamu Jimma
- Department of Nursing, College of Health Sciences, Assosa University, Assosa, Ethiopia
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Sumbi EM, Venables E, Harrison R, Garcia M, Iakovidi K, van Cutsem G, Chalachala JL. "It's a secret between us": a qualitative study on children and care-giver experiences of HIV disclosure in Kinshasa, Democratic Republic of Congo. BMC Public Health 2021; 21:313. [PMID: 33549066 PMCID: PMC7866707 DOI: 10.1186/s12889-021-10327-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background It is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). Non-disclosure – in which the child is not informed about their HIV status - is likely to be associated with poor outcomes during adolescence including increased risk of poor adherence and retention, and treatment failure. Disclosing a child’s HIV status to them can be a difficult process for care-givers and children, and in this qualitative study we explored child and care-giver experiences of the process of disclosing, including reasons for delay. Methods A total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees. Results At the time of interview, the mean age of children and care-givers was 17 (15–19) and 47 (21–70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them. Conclusions Child disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10327-5.
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Affiliation(s)
| | - Emilie Venables
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa. .,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rebecca Harrison
- Médecins Sans Frontières, Kinshasa, Democratic Republic of Congo
| | - Mariana Garcia
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Kleio Iakovidi
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Gilles van Cutsem
- Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa
| | - Jean Lambert Chalachala
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Marete I, Mwangi A, Brown S, Wools-Kaloustian K, Yiannoutsos C, Abuogi L, Lyamuya R, Ngonyani K, Achieng M, Apaka C, Rotich E, Ayaya S. FIRST- LINE ANTIRETROVIRAL TREATMENT FAILURE IN EAST AFRICAN CHILDREN. EAST AFRICAN MEDICAL JOURNAL 2021; 98:4082-4092. [PMID: 35495218 PMCID: PMC9048126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe the incidence of antiretroviral treatment failure and associated factors in a pediatric clinical cohort within the East African International epidemiology Databases to Evaluate AIDS (EA-IeDEA) consortium. DESIGN A retrospective cohort study. Clinical treatment failure was defined as advancement in clinical WHO stage, or CDC class at least 24 weeks after initiation of treatment. Immunological failure was defined as developing or returning to the following age-related immunological thresholds after at least 24 weeks on treatment; CD4 count of <200 or CD4%<10% for children aged 2-5 years and CD4 count of < 100 for a child aged > 5years. SETTING The study utilized the electronic medical records of HIV-infected pediatric patients enrolled into the EA-IeDEA consortium clinics from January 2005 to August 2012. RESULTS A total of 5927 children were included in the analysis. The estimated cumulative incidence of clinical ART treatment failure at one year and four years post ART initiation was11.5% and 31% respectively, while that of immunological treatment failure was at 3% and 22.5% respectively. The main factors associated with clinical failure were advanced clinical stage at ART-initiation, year started ART and residing in a rural area. Factors associated with immunological failure were male gender and age of the child at ART-initiation. Only 6% of those identified as having clinical treatment failure were switched to second line treatment during the four years of follow-up. CONCLUSION The probability of clinical and immunologic failure was relatively high and increased with time.
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Affiliation(s)
- Irene Marete
- Department of Pediatrics and Child Health, Moi University School of Medicine, P.O. Box 4606-30100 Kenya
| | - Ann Mwangi
- Department of Behavioral Sciences, Moi University School of Medicine, P.O. Box 4606-30100 Kenya
| | - Steven Brown
- Department of Biostatistics, Indiana University School of Medicine, 410 W. 10th Street, Suite 3000 Indianapolis, IN 46202- 3002
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University School of Medicine, Rotary Building Room 132B 702 Rotary Circle Indianapolis, IN, USA 46202
| | - Constantin Yiannoutsos
- R.M. Fairbanks School of Public Health, Department of Biostatistics, Indiana University School of Medicine,410 W. 10th Street, Suite 3000 Indianapolis, IN 46202- 3002
| | - Lisa Abuogi
- University of Colorado, Denver, Colorado. 13199 East Montview Blvd, Suite 310 Mail Stop A090, Aurora, CO, USA 80045
| | - Rita Lyamuya
- Morogoro Regional Referral Hospital, P.O.BOX 110, Morogoro, Tanzania
| | - Kapella Ngonyani
- Tumbi Regional Referral Hospital P. O. Box 30041, Kibaha, Pwani, Tanzania
| | - Marion Achieng
- Infectious Diseases Institute, College of Health Sciences, Makerere University, 3 rd Floor, West Wing, IDI Knowledge Centre, Makerere University Main Campus, P.O Box 22418, Kampala Uganda
| | - Cosmas Apaka
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100 Kenya
| | - Elyne Rotich
- Academic Model Providing Access to Health Care (AMPATH), P.O. Box 4606-30100 Kenya
| | - Samuel Ayaya
- Department of Pediatrics and Child Health, Moi University School of Medicine, P.O. Box 4606-30100 Kenya
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Mshweshwe-Pakela N, Hansoti B, Mabuto T, Kerrigan D, Kubeka G, Hahn E, Charalambous S, Hoffmann CJ. Feasibility of implementing same-day antiretroviral therapy initiation during routine care in Ekurhuleni District, South Africa: Retention and viral load suppression. South Afr J HIV Med 2020; 21:1085. [PMID: 32934830 PMCID: PMC7479383 DOI: 10.4102/sajhivmed.v21i1.1085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background Same-day initiation (SDI) of antiretroviral therapy (ART) has been advocated as an approach to increase linkage to care and overall ART initiation. Clinical trials have demonstrated impressive benefits. However, questions regarding patient preparedness and retention in care remain for routine implementation of this approach. Objectives In this study, we sought to describe SDI of ART during routine care delivery and compare time to ART initiation on longitudinal care outcomes. Method We performed a retrospective chart review of 100 consecutive individuals, newly diagnosed with HIV, from 10 health facilities across Ekurhuleni, from January to July 2017. Records were reviewed for a period of 1 year post-diagnosis. Abstracted data included demographics, time to ART initiation, clinic visits and laboratory test results (including viral load testing). Results A total of 993 patient records were reviewed, of which 826 were included in the analysis. The majority of patients (752, 91%) had ART initiation recorded, of which 654 (79%) had ART initiated within 30 days, and 224 (27%) had SDI. Uptake of SDI of ART was higher among women (36% vs. 10.4%; p < 0.001) and in younger patients (33.7% in those < 29 years; p < 0.01). Retention in care at 6 months was achieved in 477 (58%) patients. Of those with 6-month viral loads, 350/430 (73%) had a viral load < 400 c/m. Retention in care and viral suppression were similar among those with SDI of ART and later ART initiation. Conclusion Same-day initiation of ART was successfully delivered with similar retention and viral load outcomes as subsequent initiation, providing re-assurance for scale-up of this strategy in routine care.
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Affiliation(s)
| | - Bhakti Hansoti
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, United States of America.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Tonderai Mabuto
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Deanna Kerrigan
- Department of Sociology, American University, Washington, United States of America
| | - Griffiths Kubeka
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Elizabeth Hahn
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.,School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher J Hoffmann
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, United States of America.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
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9
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Verma D, Bachani D, Acharya AS, Seth A, Hemal A. Factors affecting adherence to treatment in children living with HIV. Indian J Sex Transm Dis AIDS 2020; 41:181-187. [PMID: 33817591 PMCID: PMC8000669 DOI: 10.4103/ijstd.ijstd_43_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/30/2019] [Accepted: 12/22/2019] [Indexed: 11/06/2022] Open
Abstract
Background: With the successful introduction of ART, the life expectancy of children living with HIV (CLHIV) is substantially increased. However, strict compliance is a necessary step to begin with as noncompliance is again associated with its own demerits of incomplete suppression and decreasing the overall survival of the patients. Aims: The aim of this study was to measure factors associated with adherence to ART among CLHIV. Materials and Methods: This is a 1-year follow-up study conducted from November 2012 to December 2013. A total of 171 children between 18 months and 15 years living with HIV and on ART attending the two ART centers of Delhi were enrolled in the study. Adherence and factors affecting adherence were obtained from the study participants using a semi-structured interview schedule. Statistical Analysis Used: Collected data were transformed into variables and analyzed into SPSS. All observations were in terms of mean, median, standard deviations, percentages, and proportions. Tests of significance such as Chi-square test and t-test were applied wherever required. Results: In nearly 89% of the study participants, adherence to ART was ≥95% at the end of the study. The most common reason for nonadherence was forgetfulness (59%), and 57% of the parents/caretakers were facing monetary problems. Long distance, greater duration to reach center, and unavailability of the parents/caretakers were also quoted as problems. Conclusion: Adherence is genesis to successful treatment outcome and is strongly associated with availability of support by their parents/caretakers. Professional help along with guidance and encouragement is required not only at the caretaker level but also to the family as a whole.
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Affiliation(s)
- Deepshikha Verma
- Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
| | - Damodar Bachani
- Deputy Project Director, John Snow India Private Limited, New Delhi, India
| | - Anita Shankar Acharya
- Department of Community Medicine and, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Anju Seth
- Department of Pediatrics, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Alok Hemal
- Department of Pediatrics, Lady Hardinge Medical College and Associated Hospitals,, New Delhi, India
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Yehualashet F, Tegegne E, Tessema M, Endeshaw M. Human immunodeficiency virus positive status disclosure to a sexual partner and its determinant factors in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2020; 20:382. [PMID: 32471358 PMCID: PMC7257234 DOI: 10.1186/s12879-020-05081-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/11/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Disclosure of Human Immunodeficiency Virus positive status significantly reduced the transmission of HIV; yet, it remains a challenge for many HIV patients. Disclosure serves plays a crucial role to raise awareness and to reduce risky behaviors. Hence, this study aimed to determine the pooled prevalence and effect sizes of determinant factors of HIV positive status disclosure through a systematic review and meta-analysis of the results of the existing primary studies in Ethiopia. METHOD This systematic review and meta-analysis was aimed to determine prevalence of HIV positive status disclosure and associated factors by considering and searching published primary articles from different sources. A sensitivity test was conducted to evaluate the presence of influential studies. Besides, the heterogeneity test has been conducted; and publication bias was examined through observing the funnel plot as well as objectively by interpreting the Egger's regression test. Following the Egger's regression test, P-value < 0.05 was considered as statistically significant at 95% Confidence Interval. RESULT A total of 18 primary studies were searched from different data sources. The overall pooled prevalence of HIV positive status disclosure among adult PLWHA in Ethiopia was indicated to be 75.95% (95% CI:69.93-81.98); the highest and lowest pooled estimated HIV status disclosure was in Amhara (82.78%) and Tigray (54.31%) regions respectively. Furthermore, Knowing the HIV positive status of sexual partner, AOR = 19.66(95% CI: 10.19-37.91), having prior discussion about HIV testing with their partner, AOR = 9.18(95% CI: 5.53-15.24), got Human Immunodeficiency Virus pretest counseling service AOR = 4.29(95% CI: 2.56-7.21) and being a member of HIV/AIDS associations, AOR = 3.34(95% CI: 2.17-5.12), were significantly associated with HIV positive status disclosure among People living With HIV/AIDS in Ethiopia. CONCLUSION The pooled national estimate of HIV/AIDS positive status disclosure is low as compared to the WHO disclosure rate of developing countries and the findings of other national and international studies. Ministry of health and other stakeholders shall design new approaches and strategies to encourage disclosure of HIV status, educate the public about the negative impact of nondisclosure within family members. Health care providers working at Human HIV test centers shall emphasis extensive counseling on disclosure of status to a partner. Moreover, different stakeholders, health workers and community members shall establish, organize, and support HIV/AIDS Associations and motivate HIV positive people to be engaged and participated.
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Affiliation(s)
- Fikadu Yehualashet
- Department of community health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eleni Tegegne
- Department of community health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mekbib Tessema
- Leshimaniasis Research and treatment Center, University of Gondar Hospital, Gondar, Ethiopia
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11
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Wagnew F, Eshetie S, Alebel A, Tesema C, Kibret GD, Gebrie A, Dessie G, Abajobir AA. Burden of anemia and its association with HAART in HIV infected children in Ethiopia: a systematic review and meta-analysis. BMC Infect Dis 2019; 19:1032. [PMID: 31801471 PMCID: PMC6894299 DOI: 10.1186/s12879-019-4656-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 11/22/2019] [Indexed: 11/15/2022] Open
Abstract
Background Anemia is a common problem in HIV (human immunodeficiency virus) infected patients, and is associated with decreased functional capacity and quality of life. Ethiopia is one of the countries which has expanded highly active antiretroviral treatment (HAART) over the past years. The effect of HAART on anemia among HIV remains inconsistent and inconclusive, particularly in children. This study thus aimed to synthesize the prevalence of anemia among HIV infected Ethiopian children and its association with HAART initiation. Methods MEDLINE/PubMed, EMBASE, PsycINFO, Web of Science and Google scholar were used to identify 12 eligible studies reporting an association between anemia and HIV using a priori set criteria. PRISMA guideline was used to systematically review and meta-analysis these studies. Details of sample size, magnitude of effect sizes, including odds ratio (OR) and standard errors were extracted. Random-effects model was used to calculate the pooled estimates using STATA/SE version-14. I2 and meta-bias statistics assessed heterogeneity and publication bias of the included studies. Sub-group analyses, based on study designs, were also carried out. Results In Ethiopia, the overall prevalence of anemia in HIV infected children was 22.3% (95% CI: 18.5–26.0%). The OR of anemia-HIV/AIDS comorbidity was 0.4 (95% CI, 0.2–0.5) in HAART initiated children as compared to non-initiated counterparts. Meta-bias and funnel plot detected no publication bias. Conclusion On aggregate, anemia is a common comorbidity in pediatric HIV patients. HAART was significantly associated with a reduced anemia-HIV/AIDS comorbidity. Prompt start of HAART might help decreasing the prevalence of anemia and its subsequent complications.
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Affiliation(s)
- Fasil Wagnew
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Setegn Eshetie
- College of Health Science, University of Gondar, Gondar, Ethiopia
| | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Faculity of health, University of Technology Sidney, Sidney, Australia
| | - Cheru Tesema
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Faculity of health, University of Technology Sidney, Sidney, Australia
| | - Getiye Dejenu Kibret
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia.,Faculity of health, University of Technology Sidney, Sidney, Australia
| | - Alemu Gebrie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getenet Dessie
- College of Health Sciences, Bahirdar University, Bahirdar, Ethiopia
| | - Amanuel Alemu Abajobir
- Faculty of Medicine, The University of Queensland, Brisbane, Australia.,African Population and Health Research Center, Maternal and Child Wellbeing Unit, Nairobi, Kenya
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12
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Virologic Failure in Different Antiretroviral Regimens Among Pediatric Patients with HIV Referring to a Voluntary Counseling and Testing (VCT) Center in Tehran, Iran (2004 - 2017). ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2019. [DOI: 10.5812/pedinfect.80318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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13
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Nebot Giralt A, Nöstlinger C, Lee J, Salami O, Lallemant M, Onyango-Ouma W, Nyamongo I, Marchal B. Understanding acceptance of and adherence to a new formulation of paediatric antiretroviral treatment in the form of pellets (LPV/r)-A realist evaluation. PLoS One 2019; 14:e0220408. [PMID: 31433803 PMCID: PMC6703671 DOI: 10.1371/journal.pone.0220408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/14/2019] [Indexed: 11/24/2022] Open
Abstract
Background Improving access to paediatric HIV treatment requires large-scale antiretroviral treatment programmes and medication adapted to infants and children’s needs. The World Health Organisation recommends lopinavir/ritonavir plus two nucleoside reverse transcriptase inhibitors as first-line treatment for all HIV-infected children younger than three years, usually given as a syrup. A pellet formulation (i.e. tiny cylinders of compressed medication put in capsules) was developed to overcome the syrup formulation’s disadvantages such as bitterness, toxicity and cold storage. This study assessed multi-level factors influencing caregivers’ acceptance of and adherence to lopinavir/ritonavir pellets as well as their underlying mechanisms. Methods A realist evaluation (a theory-driven evaluation method considering the social context and mechanisms of change), embedded in a clinical trial was carried out in three hospital settings in Kenya. Data were collected through document review, observations (n = 34) in home and clinic settings and semi-structured interviews (n = 44) with caregivers and providers. Data analysis was based on realist principles. Results High levels of treatment initiation and adherence were observed. Taste masking, neutral packaging and easy storage made the new formulation highly acceptable. Caregivers developed individual strategies to deliver the treatment, particularly to overcome specific problems e.g. in case of just-weaned babies or food shortage. A refined program theory emerged from the triangulated findings showing that ease of administration combined with increased self-efficacy and competences of the caregivers, and effective provider support contributed to high levels of adherence. Conclusions Formulating combined antiretroviral treatment in the form of pellets is clearly a more acceptable solution for infants and children and their caregivers compared to the syrup. Further research in non-trial settings may shed light on factors related to providers, services and the health system that contribute to better adherence of such formulations.
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Affiliation(s)
| | | | - Janice Lee
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | | | - Marc Lallemant
- Drugs for Neglected Diseases Initiative, Geneva, Switzerland
| | - Washington Onyango-Ouma
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Museum Hill, Nairobi, Kenya
| | - Isaac Nyamongo
- Institute of Anthropology, Gender and African Studies, University of Nairobi, Museum Hill, Nairobi, Kenya
| | - Bruno Marchal
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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14
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Martelli G, Antonucci R, Mukurasi A, Zepherine H, Nöstlinger C. 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. PLoS One 2019; 14:e0214014. [PMID: 30897131 PMCID: PMC6428300 DOI: 10.1371/journal.pone.0214014] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/05/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Adherence 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. METHODS This 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. RESULTS N = 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. CONCLUSION Children 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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Affiliation(s)
- Giulia Martelli
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- * E-mail:
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15
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Abdela J, Assefa A, Shamele S. Prevalence of Adverse Drug Reactions among Pediatric Patients on Antiretroviral Therapy in Selected Hospitals in Eastern Ethiopia: 8-Year Retrospective Cross-Sectional Study. J Int Assoc Provid AIDS Care 2019; 18:2325958218823208. [PMID: 30798673 PMCID: PMC6748515 DOI: 10.1177/2325958218823208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 11/30/2018] [Accepted: 12/10/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Antiretroviral-related adverse drug reactions (ADRs) are one of the leading causes of drug changes, poor adherence, and treatment failure. Therefore, this study was designed to assess the magnitude of ADR and associated factors among pediatric patients on antiretroviral therapy (ART). METHODS A retrospective cross-sectional study was conducted by reviewing the medical records of pediatric patients on ART at Hiwot Fana Specialized University Hospital and Jugal Hospital ART clinics. The collected data were coded, entered, and analyzed using SPSS, IBM version 16. The associations of selected categorical variables were done using binary logistic and multivariate logistic regression. RESULTS Of 186 medical records of pediatric patients on ART, 153 (82.25%) were reviewed. From the total medical records assessed, ADRs were observed in 23 (15.03%) of pediatric patients on ART, of which the most commonly encountered ADRs were anemia (34.8%) and followed by rash (17.4%). Most of ADRs were ranked as grade 3 (39.13%) and followed by grade 2 (30.4%) based on the degree of their severity. The likelihood of developing ADR was significantly associated with the regimen AZT/3TC/NVP (adjusted odds ratio: 6.420; 95% confidence interval: 1.056-39.018) relative to pediatric patients on D4T/3TC/NVP regimen. CONCLUSION This study indicated that few pediatric patients on ART experienced ADRs. Most of the observed ADRs were ranked as grade 2 and 3 in terms of their severity. Drug out of stock and ADRs were the 2 most common reasons for antiretroviral (ARV) drug regimen change that could affect patient's treatment outcome and limited future option.
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Affiliation(s)
- Jemal Abdela
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Anteneh Assefa
- Department of Pharmacy, College of Medical and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Sufiyan Shamele
- School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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16
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Nichols JS, Kyriakides TC, Antwi S, Renner L, Lartey M, Seaneke OA, Obeng R, Catlin AC, Gan G, Reynolds NR, Paintsil E. High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana. AIDS Care 2018; 31:25-34. [PMID: 30235940 DOI: 10.1080/09540121.2018.1524113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Adherence to antiretroviral therapy (ART) remains one of the greatest obstacles in pediatric HIV care. We sought to determine the prevalence of adherence to ART among undisclosed HIV-infected children and adolescents in Ghana. We analyzed baseline data from HIV-infected children and adolescents aged 7-18 years old enrolled in the SANKOFA Pediatric HIV disclosure intervention study in Ghana. Antiretroviral medication adherence was measured using caregiver 3-day recall; child 3-day recall; and pharmacy records for antiretroviral time-to-refill. Four hundred and twenty child-caregiver dyads were enrolled from January 2013 to June 2016. The median adherence (interquartile range), as measured by time-to-refill, was 93.2% (68.0%-100.0%). However, only 47.5% of children had ≥95% adherence ("good adherence") using time-to-refill data. Children of caregivers who had received secondary or higher level of education versus no school (aOR, 2.90, 95% Confidence Interval, CI 1.29-6.56), p = 0.010) or elementary education only (aOR, 2.20, CI, 1.24-3.88, p = 0.007) were more likely to have "good adherence" (≥95%). In this cohort of children unaware of their HIV positive status, median ART adherence rate was sub-optimal (by World Health Organization definition) while 38% had poor adherence (<85%).
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Affiliation(s)
- Justin S Nichols
- a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA
| | - Tassos C Kyriakides
- b Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Sampson Antwi
- c Department of Child Health , School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Lorna Renner
- d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Margaret Lartey
- e Department of Medicine , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Obedia A Seaneke
- d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Raphael Obeng
- c Department of Child Health , School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Ann C Catlin
- f Rosen Center for Advanced Computing , Purdue University , West Lafayette , IN , USA
| | - Geliang Gan
- b Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA
| | | | - Elijah Paintsil
- a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA
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- a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA
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Adherence to Highly Active Antiretroviral Therapy Among Children in Ethiopia: A Systematic Review and Meta-analysis. AIDS Behav 2018; 22:2513-2523. [PMID: 29761291 PMCID: PMC6097744 DOI: 10.1007/s10461-018-2152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adherence to highly active antiretroviral therapy (HAART) is the mainstay of the strategy in reducing morbidity and mortality of HIV-infected children. Different primary studies were conducted in Ethiopia. Thus, we aimed to conduct a meta-analysis of the national prevalence of optimal adherence to HAART in children. In addition, associated factors of HAART adherence were reviewed. A weighted inverse variance random-effects model was applied. The 88.7 and 93.7% of children were adhering to HAART at 07 and 03 days prior to an interview respectively. The subgroup analysis showed that HAART adherence was 93.4% in Amhara, 90.1% in Addis Ababa and 87.3% in Tigray at 07 days prior to an interview. Our study suggests that, within short window reported time, adherence to HAART in Ethiopian children may be in a good progress. Emphasis on specific adherence interventions need further based on individual predictors to improve overall HAART adherence of children.
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Wadunde I, Tuhebwe D, Ediau M, Okure G, Mpimbaza A, Wanyenze RK. Factors associated with adherence to antiretroviral therapy among HIV infected children in Kabale district, Uganda: a cross sectional study. BMC Res Notes 2018; 11:466. [PMID: 30001748 PMCID: PMC6043986 DOI: 10.1186/s13104-018-3575-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022] Open
Abstract
Objectives This study was set out to assess the level of adherence to antiretroviral therapy (ART) and its determinants among children receiving HIV treatment in Kabale district, south western Uganda, in order to inform interventions for improving pediatric ART adherence. Results Overall, 79% (121/153) of the children did not miss ART doses over the 7 days. Caregiver forgetfulness was the major reason for missing ART doses, 37% (13/35). Other reasons included transportation costs to the health facilities, 17%, (6/35) and children sitting for examinations in schools. Older children (11–14 years) were more likely to adhere to ART than the younger ones (0–10 years) (AOR = 6.41, 95% CI 1.31–31.42). Caregivers, who knew their HIV status, had their children more adherent to ART than the caregivers of unknown HIV status (AOR = 21.64: 95% CI 1.09–428.28). A significant proportion of children in two facilities 21.5% (32/153) missed ART doses within the previous week. Support for providers to identify clues or reminders to take drugs, extending HIV testing to caregivers and innovative models of ART delivery that alleviate transport costs to caregivers and allow sufficient drugs for children in school could enhance drug adherence among children.
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Affiliation(s)
- Ignatius Wadunde
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda.
| | - Doreen Tuhebwe
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Michael Ediau
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Gildo Okure
- Department of Health Policy, Planning and Management, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
| | - Arthur Mpimbaza
- Child Health and Development Centre, Makerere University College of Health Sciences School of Medicine, P.O. Box 6717, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences School of Public Health, P.O Box 7072, Kampala, Uganda
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Low YS, Islahudin F, Razali KAM, Adnan S. Modification of Initial Highly Active Antiretroviral Therapy (HAART) Regimen in Paediatric HIV Patients. Open AIDS J 2018; 12:11-19. [PMID: 29576815 PMCID: PMC5850481 DOI: 10.2174/1874613601812010011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 10/11/2017] [Accepted: 01/30/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Treatment options among Human Immunodeficiency Virus (HIV)-infected children are limited as only a few Highly Active Antiretroviral Therapy (HAART) are approved worldwide for paediatric use. Among children, frequent changes in HAART regimen can rapidly exhaust treatment options, and information addressing this issue is scarce. OBJECTIVE The aim of the study was to determine factors associated with the modification of initial HAART regimen modification among HIV-infected children. METHOD A retrospective study was performed among HIV-infected children aged 18 and below, that received HAART for at least six months in a tertiary hospital in Malaysia. Factors associated with modification of initial HAART regimen were investigated. RESULTS Out of 99 patients, 71.1% (n=71) required initial HAART regime modification. The most common reason for HAART modification was treatment failure (n=39, 54.9%). Other reasons included drug toxicity (n=14, 19.7%), change to fixed-dose products (n=11, 15.5%), product discontinuation (n=4, 5.6%) and intolerable taste (n=3, 4.2%). The overall mean time retention on initial HAART before regimen modification was 3.32 year ± 2.24 years (95% CI, 2.79-3.85). Patient's adherence was the only factor associated with initial regimen modification in this study. Participants with poor adherence showed a five-fold risk of having their initial HAART regimen modified compared to those with good adherence (adjusted OR [95% CI], 5.250 [1.614 - 17.076], p = 0.006). CONCLUSION Poor adherence was significantly associated with initial regimen modification, intervention to improve patient's adherence is necessary to prevent multiple regimen modification among HIV-infected children.
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Affiliation(s)
- Yee Shan Low
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
| | | | - Shafnah Adnan
- Hospital Kuala Lumpur, Jalan Pahang, 50586 Kuala Lumpur, Malaysia
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Tadesse BT, Kinloch NN, Baraki B, Lapointe HR, Cobarrubias KD, Brockman MA, Brumme CJ, Foster BA, Jerene D, Makonnen E, Aklillu E, Brumme ZL. High Levels of Dual-Class Drug Resistance in HIV-Infected Children Failing First-Line Antiretroviral Therapy in Southern Ethiopia. Viruses 2018; 10:E60. [PMID: 29389912 PMCID: PMC5850367 DOI: 10.3390/v10020060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/30/2018] [Accepted: 01/30/2018] [Indexed: 11/29/2022] Open
Abstract
Clinical monitoring of pediatric HIV treatment remains a major challenge in settings where drug resistance genotyping is not routinely available. As a result, our understanding of drug resistance, and its impact on subsequent therapeutic regimens available in these settings, remains limited. We investigate the prevalence and correlates of HIV-1 drug resistance among 94 participants of the Ethiopia Pediatric HIV Cohort failing first-line combination antiretroviral therapy (cART) using dried blood spot-based genotyping. Overall, 81% (73/90) of successfully genotyped participants harbored resistance mutations, including 69% (62/90) who harbored resistance to both Nucleoside Reverse Transcriptase Inhibitors (NRTIs) and Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs). Strikingly, 42% of resistant participants harbored resistance to all four NRTIs recommended for second-line use in this setting, meaning that there are effectively no remaining cART options for these children. Longer cART duration and prior regimen changes were significantly associated with detection of drug resistance mutations. Replicate genotyping increased the breadth of drug resistance detected in 34% of cases, and thus is recommended for consideration when typing from blood spots. Implementation of timely drug resistance testing and access to newer antiretrovirals and drug classes are urgently needed to guide clinical decision-making and improve outcomes for HIV-infected children on first-line cART in Ethiopia.
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Affiliation(s)
| | - Natalie N Kinloch
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Bemuluyigza Baraki
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Hope R Lapointe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Kyle D Cobarrubias
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Mark A Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Chanson J Brumme
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Byron A Foster
- Departments of Dermatology and Pediatrics, Oregon Health Sciences University, Portland, OR 97239, USA.
| | - Degu Jerene
- Management Sciences for Health, Addis Ababa 1250, Ethiopia.
| | - Eyasu Makonnen
- Department of Pharmacology, College of Health Sciences, Addis Ababa University, Addis Ababa 9086, Ethiopia.
| | - Eleni Aklillu
- Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institute, Karolinska University Hospital Huddinge C1:68, Stockholm 141 86, Sweden.
| | - Zabrina L Brumme
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
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Challenges and perspectives of compliance with pediatric antiretroviral therapy in Sub-Saharan Africa. Med Mal Infect 2017; 47:511-518. [PMID: 28943171 DOI: 10.1016/j.medmal.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 10/17/2016] [Accepted: 07/20/2017] [Indexed: 11/22/2022]
Abstract
More than 3 million children aged less than 15years are infected with HIV worldwide, mainly in Sub-Saharan Africa. The survival of HIV-infected children depends on their access to antiretroviral therapy whose success mainly depends on a good life-long compliance with antiretroviral therapy. Given its complexity and specificity, assessment and monitoring of pediatric compliance with antiretroviral therapy is a major challenge. There is no consensus on a gold standard for monitoring compliance with antiretroviral therapy. Compliance is also influenced by many factors related to the child, the caregiver, the healthcare staff, the healthcare system, and antiretroviral drugs. This review aimed to assess scientific knowledge on pediatric compliance with antiretroviral therapy in Sub-Saharan Africa, and to identify areas for future interventions to improve compliance. Good compliance is essential to achieve the "90% coverage of children on antiretroviral therapy" gold standard of the World Health Organization, and to eliminate HIV infection by 2030.
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Firdu N, Enquselassie F, Jerene D. HIV-infected adolescents have low adherence to antiretroviral therapy: a cross-sectional study in Addis Ababa, Ethiopia. Pan Afr Med J 2017; 27:80. [PMID: 28819501 PMCID: PMC5554655 DOI: 10.11604/pamj.2017.27.80.8544] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/19/2016] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION For antiretroviral therapy (ART) to work effectively, adherence is very crucial. However, most studies done on ART adherence are either on children or on adults. There is limited information on the level of adherence among adolescents. METHODS Using a cross-sectional study design, we interviewed 273 HIV-infected adolescents receiving ART from three hospitals in Addis Ababa. We used a structured questionnaire to measure adherence levels using patient self-reports. Bivariate and multivariate methods were used for analysis. RESULTS We interviewed 273 adolescents aged 13 to 19 years, and 144 (52.7%) of the participants were girls. Their mean age was 15.4 years (SD± 1.75). The self-reported adherence rate of the respondents was 79.1% (216/273). On bivariate analysis, variables like WHO clinical stage, being on Cotrimoxazole Prophylactic Therapy (CPT), marital and living status of the parent, whether parent was on ART or not and having special instructions for ART medications were associated with optimum adherence. However of those, only WHO stage IV (adjusted OR, 12.874 95% CI, 2.079-79.706), being on CPT (adjusted OR, 0.339 95% CI, 0.124-0.97) and adolescents with widowed parent (adjusted OR, 0.087 with 95% CI, 0.021-0.359) were found to be significantly associated with optimum ART adherence. CONCLUSION The level of self-reported ART adherence among HIV-infected adolescents at the three hospitals was below the recommended threshold. Though earlier presentation of adolescents to care should be encouraged, more targeted adherence support should be planned for those who present at an early stage of their illness.
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Affiliation(s)
- Naod Firdu
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Addis Ababa, Ethiopia
| | - Fikre Enquselassie
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Addis Ababa, Ethiopia
| | - Degu Jerene
- Addis Ababa University, School of Public Health, Department of Preventive Medicine, Addis Ababa, Ethiopia.,Management Sciences for Health (MSH), Addis Ababa, Ethiopia
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Tsegay YG, Tadele A, Addis Z, Alemu A, Melku M. Magnitude of cytopenias among HIV-infected children in Bahir Dar, northwest Ethiopia: a comparison of HAART-naïve and HAART-experienced children. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2017; 9:31-42. [PMID: 28260948 PMCID: PMC5325102 DOI: 10.2147/hiv.s125958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background AIDS, caused by HIV, is a multisystem disease that affects hematopoiesis. The aim of this study was to assess cytopenias among HIV-infected children who had a follow-up at Felege Hiwot Referral Hospital, Bahir Dar, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted between April and May 2013. Systematic random sampling method was used to select the study participants. Descriptive statistics, independent t-test as well as chi-square and logistic regression were used for analysis. A p-value <0.05 was considered as statistically significant. Results A total of 224 children (112 highly active antiretroviral therapy [HAART]-naïve and 112 HAART-experienced) participated in the study. The magnitude of anemia, thrombocytopenia, neutropenia, leukopenia and pancytopenia among HAART-naïve HIV-infected children were 30.4%, 9.8%, 8%, 4.5% and 1.8%, respectively. The overall prevalence of anemia, neutropenia, thrombocytopenia, leukopenia and pancytopenia were 29.5%, 8.9%, 8%, 4.5% and 1.4%, respectively. Cluster of differentiation-4 percentage and mean corpuscular volume were significantly different between HAART-experienced and HAART-naïve children. Being of younger age and severely immunosuppressed were risk factors of anemia. Conclusion Anemia was the most common cytopenia, followed by neutropenia. Severe immunosuppression and younger age were significantly associated with anemia. Therefore, emphasis should be given for investigation and management of cytopenias in HIV-infected children, particularly for those who are immunosuppressed and of younger age.
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Affiliation(s)
| | | | | | - Agersew Alemu
- Department of Medical Parasitology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Akahara C, Nwolisa E, Odinaka K, Okolo S. Assessment of Antiretroviral Treatment Adherence among Children Attending Care at a Tertiary Hospital in Southeastern Nigeria. J Trop Med 2017; 2017:3605850. [PMID: 28261274 PMCID: PMC5316446 DOI: 10.1155/2017/3605850] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/08/2016] [Accepted: 01/15/2017] [Indexed: 11/17/2022] Open
Abstract
Background. Adherence is the strongest predictor of successful treatment outcome among children infected with HIV. Our aim was to assess the antiretroviral drugs adherence status of HIV-infected children attending care at a tertiary hospital in Southeastern Nigeria. Method. The study involved a cross-sectional survey of 210 HIV-infected children attending care at a tertiary hospital in Southeastern Nigeria using self-report method of assessment. Optimal ART adherence is defined as patient taking not missing more than 1 dose of combined antiretroviral therapy medication in the preceding 2 weeks prior to the study. Result. A majority of the subjects 191 (91%) had good adherence. There was a significant relationship between adherence and patient educational level (p = 0.004), duration of treatment (p = 0.001), drug administrator (p = 0.005), and orphan status (p = 0.001). The motivating factor for adherence was "not falling sick as before" while stigma was the most discouraging factor. Conclusion. The adherence level in this study was good. Stigma was an important reason given by patient/caregivers for nonadherence. There is need for concerted effort in addressing this barrier to improve adherence and prevent the emergence of drug resistance and treatment failure.
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Affiliation(s)
- Cletus Akahara
- Department of Paediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - Emeka Nwolisa
- Department of Paediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - Kelechi Odinaka
- Department of Paediatrics, Federal Medical Centre, Owerri, Imo State, Nigeria
| | - Seline Okolo
- Department of Paediatrics, University of Jos Teaching Hospital, Plateau State, Nigeria
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Impact of HIV-Status Disclosure on Adherence to Antiretroviral Therapy Among HIV-Infected Children in Resource-Limited Settings: A Systematic Review. AIDS Behav 2017; 21:59-69. [PMID: 27395433 DOI: 10.1007/s10461-016-1481-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric HIV remains a significant global health dilemma, especially in resource-constrained nations. As access to ART increases around the world, areas of concern in pediatric HIV treatment include age-appropriate disclosure of HIV status to children and development of adherence habits over time. This review was conducted to synthesize quantitative associations reported between disclosure and adherence among children living with HIV in resource-limited settings. An electronic database search of PubMed, MEDLINE and Cochrane returned 1348 results after removal of duplicates, 14 of which were found to meet inclusion criteria. Review of these reports showed conflicting results regarding the impact of disclosure on adherence, with 5 showing no association, 4 showing a negative impact of disclosure on adherence, and 5 showing positive benefits of disclosure for adherence habits. Thus, there was no clear consensus on the effect, if any, that disclosure has on medication adherence. Longitudinal, prospective research needs to be conducted to evaluate further impacts that disclosure may have on adherence habits over time, and interventions must be structured to link the two processes together in order to maximize health benefit to the child or adolescent.
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Biru M, Jerene D, Lundqvist P, Molla M, Abebe W, Hallström I. Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia. AIDS Care 2016; 29:436-440. [PMID: 27842440 DOI: 10.1080/09540121.2016.1257098] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
To achieve optimal virologic suppression for children undergoing antiretroviral therapy (ART), adherence must be excellent. This is defined as taking more than 95% of their prescribed doses. To our knowledge, no study in Ethiopia has evaluated the level of treatment adherence at the beginning of the child's treatment. Our aim was therefore to evaluate caregiver-reported ART non-adherence among children and any predictors for this during the early course of treatment. We conducted a prospective cohort study of 306 children with HIV in eight health facilities in Ethiopia who were registered at ART clinics between 20 December 2014 and 20 April 2015. The adherence rate reported by caregivers during the first week and after a month of treatment initiation was 92.8% and 93.8%, respectively. Our findings highlight important predictors of non-adherence. Children whose caregivers were not undergoing HIV treatment and care themselves were less likely to be non-adherent during the first week of treatment (aOR = 0.17, 95% CI: 0.04, 0.71) and the children whose caregivers did not use a medication reminder after one month of treatment initiation (aOR = 5.21, 95% CI: 2.23, 12.16) were more likely to miss the prescribed dose. Moreover, after one month of the treatment initiation, those receiving protease inhibitor (LPV/r) or ABC-based treatment regimens were more likely to be non-adherent (aOR = 12.32, 95% CI: 3.25, 46.67). To promote treatment adherence during ART initiation in children, particular emphasis needs to be placed on a baseline treatment regimen and ways to issue reminders about the child's medication to both the health care system and caregivers. Further, large scale studies using a combination of adherence measuring methods upon treatment initiation are needed to better define the magnitude and predictors of ART non-adherence in resource-limited settings.
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Affiliation(s)
- Mulatu Biru
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden
| | - Degu Jerene
- c Management Sciences for Health , Addis Ababa , Ethiopia
| | - Pia Lundqvist
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden
| | - Mitikie Molla
- b School of Public Health, Addis Ababa University , Addis Ababa , Ethiopia
| | - Workeabeba Abebe
- d Department of Paediatrics and Child Health , School of Medicine, Addis Ababa University , Addis Ababa , Ethiopia
| | - Inger Hallström
- a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden
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Assessing Adherence to Antiretroviral Therapy in a Rural Paediatric Cohort in KwaZulu-Natal, South Africa. AIDS Behav 2016; 20:2729-2738. [PMID: 27289369 DOI: 10.1007/s10461-016-1419-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Achieving optimal adherence to ARV's in a rural paediatric population is challenging. Monitoring adherence by frequent viral load assay is not always feasible or sustainable in rural communities. A relatively cheaper, reliable, valid and sustainable measure of adherence for children is required for routine management. This study retrospectively assessed adherence outcomes using monthly pill count and viral load data, including reasons reported for non-adherence, in a paediatric cohort in rural KwaZulu-Natal, South Africa. Between 2008 and 2013, 78 children, mean age of 7.1 years, were enrolled in the CAPRISA 052 AIDS Treatment Programme. Monthly treatment adherence by pill count was categorized as either high (≥95 %) or low (<95 %). Overall median monthly adherence to treatment by pill count was 87.8 % at month 6, 88.9 % at month 12 and 90.8 % at month 24. However, the proportion of children with an undetectable viral load (<400 copies/ml) was 84.0 % (63/74), 86.6 % (58/67), and 84.5 % (49/58) at the three time points respectively. Agreement between pill count and viral load showed that only 33.9, 36. 3 and 30.6 % of children were truly adherent by pill count at months 6, 12 and 24 respectively. In conclusion, this treatment programme demonstrated that adherence of >95 % by pill count is not an ideal indicator of virological suppression in children aged 6 months to 13 years. Viral load assessment remains the gold standard for assessing treatment success in this age group.
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Megerso A, Garoma S, Eticha T, Workineh T, Daba S, Tarekegn M, Habtamu Z. Predictors of loss to follow-up in antiretroviral treatment for adult patients in the Oromia region, Ethiopia. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2016; 8:83-92. [PMID: 27175095 PMCID: PMC4854271 DOI: 10.2147/hiv.s98137] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Purpose It is known that antiretroviral treatment (ART) reduces mortality from acquired immunodeficiency syndrome related causes. Patient’s lost to follow-up (LTFU) in this treatment poses a paramount problem to the public and health care services. Information on predictors of loss to follow-up is scarce in this study area and similar settings. Therefore, this study aimed at identifying correlates of loss to follow-up in ART among adult patients in the Oromia region of Ethiopia. Methods A case–control study was conducted between February 2015 and April 2015 using medical records. The stratified sampling technique was used to select health facilities. The number of patient records to be included in the study was proportionally allocated to each stratum based on their patient proportion in the regional data. Specific health facilities from which to include the records were randomly selected from a list of the health facilities per stratum. All adult patient records registered as LTFU (416) in the selected health facilities during the 12-month period prior to the data collection date, and 832 patients with good adherence to ART were included. Data were double-entered into Epi Info 7 and analyzed using SPSS 20. Descriptive statistics and binary logistic regression were used to report the results. Qualitative data were thematically analyzed using open code computer software. Results Age 15–24 years (adjusted odds ratio [AOR], 19.82 95% CI: 6.80, 57.73); day laborers (AOR, 5.36; 95% confidence interval [CI]: 3.23, 8.89), rural residents (AOR, 2.35; 95% CI: 1.45, 3.89), World Health Organization clinical stage IV (AOR, 2.29; 95% CI: 1.45, 3.62), baseline CD4 <350 cells/mL (AOR, 2.06; 95% CI: 1.36, 3.13), suboptimal adherence to ART (AOR, 7.42; 95% CI: 1.87, 29.41), were factors which increased the risk of loss to follow-up in ART. Conclusion Multiple risk factors, both socioeconomic and clinical, were associated with loss to follow-up. Attention is required to address these factors during patient preparation for the treatment and follow-up counseling by practitioners. We recommend that other studies identify what happened to the patients registered as LTFU as the current study could not address this issue.
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Affiliation(s)
- Abebe Megerso
- Department of Public Health, Adama Hospital Medical College, Addis Ababa, Ethiopia
| | - Sileshi Garoma
- Department of Public Health, Adama Hospital Medical College, Addis Ababa, Ethiopia
| | - Tolosa Eticha
- Department of Pediatrics and Child Health, Adama Hospital Medical College, Addis Ababa, Ethiopia
| | - Tilaye Workineh
- Department of Public Health, Adama Hospital Medical College, Addis Ababa, Ethiopia
| | - Shallo Daba
- Oromia Regional Health Bureau, HIV/AIDS Prevention and Control Division, Addis Ababa, Ethiopia
| | - Mihretu Tarekegn
- Oromia Regional Health Bureau, HIV/AIDS Prevention and Control Division, Addis Ababa, Ethiopia
| | - Zelalem Habtamu
- Oromia Regional Health Bureau, HIV/AIDS Prevention and Control Division, Addis Ababa, Ethiopia
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29
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Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review. J Int AIDS Soc 2015; 18:20049. [PMID: 26385853 PMCID: PMC4575412 DOI: 10.7448/ias.18.1.20049] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 07/10/2015] [Accepted: 08/12/2015] [Indexed: 12/25/2022] Open
Abstract
Introduction Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. Methods We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included “adherence,” “compliance,” “antiretroviral use” and “antiretroviral adherence,” in combination with “adolescents,” “youth,” “HIV,” “Africa,” “interventions” and the MeSH term “Africa South of the Sahara.” Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. Discussion Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. Conclusions Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.
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Singer AW, Weiser SD, McCoy SI. Does Food Insecurity Undermine Adherence to Antiretroviral Therapy? A Systematic Review. AIDS Behav 2015; 19:1510-26. [PMID: 25096896 DOI: 10.1007/s10461-014-0873-1] [Citation(s) in RCA: 131] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A growing body of research has identified food insecurity as a barrier to antiretroviral therapy (ART) adherence. We systematically reviewed and summarized the quantitative literature on food insecurity or food assistance and ART adherence. We identified nineteen analyses from eighteen distinct studies examining food insecurity and ART adherence. Of the thirteen studies that presented an adjusted effect estimate for the relationship between food insecurity and ART adherence, nine found a statistically significant association between food insecurity and sub-optimal ART adherence. Four studies examined the association between food assistance and ART adherence, and three found that ART adherence was significantly better among food assistance recipients than non-recipients. Across diverse populations, food insecurity is an important barrier to ART adherence, and food assistance appears to be a promising intervention strategy to improve ART adherence among persons living with HIV. Additional research is needed to determine the effectiveness and cost-effectiveness of food assistance in improving ART adherence and other clinical outcomes among people living with HIV in the era of widespread and long-term treatment.
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Affiliation(s)
- Amanda W Singer
- Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA,
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31
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Jenabian MA, Costiniuk CT, Mboumba Bouassa RS, Chapdeleine Mekue Mouafo L, Brogan TV, Bélec L. Tackling virological failure in HIV-infected children living in Africa. Expert Rev Anti Infect Ther 2015. [PMID: 26204960 DOI: 10.1586/14787210.2015.1068117] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Drug resistance in HIV-infected children is one of the main contributors to antiretroviral treatment (ART) failure, especially in developing countries. Sub-Saharan Africa has the largest burden of pediatric HIV infection in the world. Herein, we systematically review the current status of ART failure in HIV-infected African children. A literature search for publications within 10 years was performed through PubMed to identify relevant articles. Included studies examined the impact of timing of ART initiation, criteria for diagnosing therapeutic failure, predictors of therapeutic failure, management strategies and future directions to minimize failure rates in these pediatric populations. Although there is scale-up of ART programs in Africa, novel therapeutic and management strategies are needed to overcome current challenges.
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Affiliation(s)
- Mohammad-Ali Jenabian
- a 1 Département des Sciences Biologiques et Centre de recherche BioMed, Université du Québec à Montréal (UQAM), Montreal, QC, Canada
| | - Cecilia T Costiniuk
- b 2 Chronic Viral Illnesses Service and Division of Infectious Diseases, McGill University Health Centre, Montreal, QC, Canada
| | - Ralph-Sydney Mboumba Bouassa
- c 3 Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Laboratoire de Virologie, and Faculté de Médecine Paris Descartes, Université Paris V, Paris Sorbonne Cité, Paris, France
| | - Linda Chapdeleine Mekue Mouafo
- c 3 Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Laboratoire de Virologie, and Faculté de Médecine Paris Descartes, Université Paris V, Paris Sorbonne Cité, Paris, France
| | - Thomas V Brogan
- d 4 Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - Laurent Bélec
- c 3 Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Laboratoire de Virologie, and Faculté de Médecine Paris Descartes, Université Paris V, Paris Sorbonne Cité, Paris, France
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Disclosure of their HIV status to perinatally infected youth using the adapted Blasini disclosure model in Haiti and the Dominican Republic: preliminary results. AIDS 2015; 29 Suppl 1:S91-8. [PMID: 26049543 DOI: 10.1097/qad.0000000000000665] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the safety, acceptability, and preliminary efficacy of a culturally-adapted disclosure intervention for perinatally HIV-infected combined antiretroviral therapy patients in Haiti and the Dominican Republic. DESIGN A quasi-experimental trial was conducted comparing caregiver-youth pairs who completed the intervention [adapted Blasini disclosure model (aBDM)] to pairs who discontinued aBDM participation before disclosure. aBDM consists of five components: structured healthcare worker training; one-on one pre-disclosure intervention/education sessions for youth (describing pediatric chronic diseases including cancer, diabetes and HIV) and for caregivers (strengthening capacity for disclosure); a scheduled supportive disclosure session; and one-on-one postdisclosure support for caregivers and youth. METHODS Caregivers of nondisclosed combined antiretroviral therapy patients aged 10.0-17.8 years were invited to participate. Data were collected by separate one-on-one face-to-face interviews of caregivers and youth by study staff and medical record review by pediatricians at enrollment and 3 months after disclosure or after intervention discontinuation. RESULTS To date, 65 Dominican Republic and 27 Haiti caregiver-youth pairs have enrolled. At enrollment, only 46.4% of youth had viral suppression and 43.4% of caregivers had clinically significant depressive symptomatology. To date, two serious study-related adverse events have occurred. Seven of the 92 (7.6%, 6 in the Dominican Republic) enrolled pairs discontinued participation before disclosure and 39 had completed postdisclosure participation. Median plasma HIV-RNA concentration was lower in youth who completed aBDM than in youth who discontinued participation before aBDM disclosure (<40 versus 8673 copies/ml; P = 0.027). Completers expressed considerable satisfaction with aBDM. CONCLUSION Preliminary results suggest safety, acceptability, and possible effectiveness of the aBDM.
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Iroha E, Esezobor CI, Ezeaka C, Temiye EO, Akinsulie A. Adherence to antiretroviral therapy among HIV-infected children attending a donor-funded clinic at a tertiary hospital in Nigeria. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 9:25-30. [PMID: 25860410 DOI: 10.2989/16085906.2010.484543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The success of antiretroviral therapy (ART) depends on a high level of adherence to a life-long regimen of antiretroviral drugs (ARVs). Since the scale-up of access to ARVs in Nigeria, few studies have determined the level of adherence of ART among children. This study was undertaken to determine the level of ART adherence among paediatric patients at an outpatient clinic, the reasons for non-adherence, and the factors associated with adherence, according to caregivers' reports. Out of a total of 212 children, 183 (86%) were adherent in the three days preceding the interview, while 29 (14%) were not adherent. Drug exhaustion at home (16 children), followed by 'child slept through' (7 children) and 'caregiver away' were the most common reasons for a child having missed one or more ARV doses. Independent factors for adherence were male gender (odds ratio [OR] = 2.85; 95% confidence interval [CI]: 1.17-6.92) and attendance at last scheduled clinic appointment (OR = 4.76; 95% CI: 1.73-13.04). The caregiver's highest educational attainment, distance travelled to the clinic, use of medication reminders, formulation of ARVs, duration of HAART usage, age of the child and orphan status were not significantly associated with adherence to drug treatment. The overall level of adherence was high and similar to the rate reported prior to free access to ART services in Nigeria. Among child patients on HAART, there is a need to identify factors affecting clinic attendance and drug exhaustion at home.
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Affiliation(s)
- Edna Iroha
- a Department of Paediatrics, College of Medicine , University of Lagos , PMB 12003 , Lagos , Lagos State , Nigeria
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34
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Ketema AK, Shewangizaw Weret Z. Assessment of adherence to highly active antiretroviral therapy and associated factors among people living with HIV at Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia: a cross-sectional study. HIV AIDS-RESEARCH AND PALLIATIVE CARE 2015; 7:75-81. [PMID: 25792856 PMCID: PMC4362904 DOI: 10.2147/hiv.s79328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient adherence to antiretroviral combination therapy is a critical component to successful treatment outcome. Nonadherence to antiretroviral therapy (ART) is a major challenge to AIDS care, and the risks associated with it are extensive. The intention of this study was to determine prevalence and associated factors with adherence to highly active ART among people living with HIV/AIDS (PLWHA) at the Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia. A cross-sectional study design with systematic random sampling conducted by the use of a structured, pretested self-rating adherence questionnaire was used to conduct the study among 422 respondents from the Debrebrihan Referral Hospital and Health Center. A single population proportion formula at 95% CI with 5% of marginal error at 50% of prevalence of occurrence was used to determine sample size. Adherence was defined as not missing a single ART dose during the 30-day period prior to filling out the self-report. Adherence was measured by self-reports by the patients. These results were then used in binary logistic regression analysis. Covariates were analyzed by bivariate and multivariate logistic regression with SPSS statistical software. The total number of respondents in this study was 422; their median age was 35 years. Among the participants, 95.5% were taking their medication without missing a dose. Factors such as having emotional or practical support positively encouraged ART adherence (adjusted odds ratio 0.16 [95% CI 0.05–0.49]). However, users of traditional, complementary, and alternative medicine (TCAM) (adjusted odds ratio 4.7 [95% CI 1.06–21.22]) had nearly a five times higher risk for ART nonadherence (P<0.05) than those not using TCAM. Adherence to ART among PLWA is imperative and standard. But, there is still a need to boost psychological support and practical support for the clients, and there is also a need to create a more integrative approach with TCAM in order to increase adherence to ART. Strengthening emotional and practical support for PLWHA and integrating TCAM with the proper use of ART are mandatory to enhance ART adherence.
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Affiliation(s)
- Abush Kebede Ketema
- Regional Monitoring and Evaluation Advisor, Management Sciences for Health, Addis Ababa, Ethiopia
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35
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Hudelson C, Cluver L. Factors associated with adherence to antiretroviral therapy among adolescents living with HIV/AIDS in low- and middle-income countries: a systematic review. AIDS Care 2015; 27:805-16. [PMID: 25702789 DOI: 10.1080/09540121.2015.1011073] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Adolescents living in low- and middle-income countries (LMICs) are disproportionately burdened by the global HIV/AIDS pandemic. Maintaining medication adherence is vital to ensuring that adolescents living with HIV/AIDS receive the benefits of antiretroviral therapy (ART), although this group faces unique challenges to adherence. Knowledge of the factors influencing adherence among people during this unique developmental period is needed to develop more targeted and effective adherence-promoting strategies. This systematic review summarizes the literature on quantitative observational studies examining correlates, including risk and resilience-promoting factors, of ART adherence among adolescents living with HIV/AIDS in LMICs. A systematic search of major electronic databases, conference-specific databases, gray literature, and reference lists of relevant reviews and documents was conducted in May 2014. Included studies examined relationships between at least one factor and ART adherence as an outcome and were conducted in primarily an adolescent population (age 10-19) in LMICs. The search identified 7948 unique citations from which 15 studies fit the inclusion criteria. These 15 studies identified 35 factors significantly associated with ART adherence representing a total of 4363 participants across nine different LMICs. Relevant studies revealed few consistent relationships between measured factors and adherence while highlighting potentially important themes for ART adherence including the impact of (1) adolescent factors such as gender and knowledge of serostatus, (2) family structure, (3) the burdensome ART regimens, route of administration, and attitudes about medication, and (4) health care and environmental factors, such as rural versus urban location and missed clinic appointments. Rates of adherence across studies ranged from 16% to 99%. This review identifies unique factors significantly related to ART adherence among adolescents living in LMICs. More research using longitudinal designs and rigorous measures of adherence is required in order to identify the range of factors influencing ART adherence as adolescents living with HIV/AIDS in LMICs grow into adulthood.
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Affiliation(s)
- Carly Hudelson
- a Department of Social Policy and Intervention , University of Oxford , Oxford , UK
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Ebonyi AO, Ejeliogu EU, Okpe SE, Shwe DD, Yiltok ES, Ochoga MO, Oguche S. Factors associated with antiretroviral treatment interruption in human immunodeficiency virus (HIV)-1-infected children attending the Jos University Teaching Hospital, Jos, Nigeria. Niger Med J 2015; 56:43-7. [PMID: 25657493 PMCID: PMC4314859 DOI: 10.4103/0300-1652.149170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Interrupting anti-retroviral therapy (ART) for any number of reasons is an indication of a compromised adherence to ART. Several factors, including the pill burden from other drugs used in treating co-infections in children with human immunodeficiency virus (HIV), may influence ART adherence. The aim of this study was to identify the factors associated with ART interruption in HIV-1-infected children. Materials and Methods: A retrospective cohort study analysing data on 580 children consecutively enrolled on ART between February 2006 and December 2010 at the paediatric HIV clinic of Jos University Teaching Hospital (JUTH), Jos. Subjects were children aged 2 months — 15 years diagnosed with HIV-1 infection and on first-line ART. Cotrimoxazole prophylaxis was usually commenced at diagnosis while awaiting ART commencement. Children diagnosed with tuberculosis (TB) were also placed on multiple individual anti-TB drugs. Statistical analysis used: A comparison of the data on children with and without ART interruption was made. Variables associated with ART interruption in a univariate analysis were fit in a multivariate logistic model to determine the factors that were associated with ART interruption. Results: Children on anti-TB drugs were twice more likely to interrupt ART compared to those who were not, (adjusted odds ratio, AOR = 1.84 (1.03-3.28); P = 0.04). But children on cotrimoxazole prophylaxis had a 57% reduction in the odds of interrupting ART compared to those who were not, (AOR = 0.43 (0.20-0.93); P = 0.03). Conclusion: Children on ART and also taking multiple individual anti-TB drugs should be monitored closely for ART adherence. Cotrimoxazole prophylaxis should be encouraged in children diagnosed with HIV while awaiting ART commencement as this may prime them for a better ART adherence.
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Affiliation(s)
- Augustine O Ebonyi
- Department of Paediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Emeka U Ejeliogu
- Department of Paediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Sylvanus E Okpe
- Department of Paediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - David D Shwe
- Department of Paediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Esther S Yiltok
- Department of Paediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
| | - Martha O Ochoga
- Department of Paediatrics, Benue State University Teaching Hospital, Makurdi, Nigeria
| | - Stephen Oguche
- Department of Paediatrics, University of Jos/Jos University Teaching Hospital, Jos, Nigeria
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Interruption of cART in clinical practice is associated with an increase in the long-term risk of subsequent immunosuppression in HIV-1-infected children. Pediatr Infect Dis J 2014; 33:1237-45. [PMID: 24945880 DOI: 10.1097/inf.0000000000000450] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Antiretroviral treatment interruption (TI) is not recommended in HIV-infected children. We aimed to evaluate the context and consequences of TI in clinical practice. METHODS We investigated the probability and risk factors of a first TI in the 483 children treated with combined ART (cART) in the ANRS French national pediatric cohort. Immunologic and virologic outcomes were compared between patients with TI (TI group) and those on continuous treatment (matched control group), from a baseline defined as the age at first interruption for the TI child and the corresponding age for the control child. RESULTS At least one TI ≥ 3 months occurred in 42.4% of patients, at a median age of 8.0 years, for a median duration of 12.1 months. After cART initiation, the risk of TI was 7.0% (5.0-9.6) at 1 year and 30.3% (26.1-35.0) at 5 years and was higher for children starting treatment before 2000 and for children starting cART before 6 months of age. AIDS-free survival was similar, but severe immunosuppression occurred earlier in the TI group than in the control group (adjusted HR = 3.1; 1.0-9.1; P = 0.04). Four years after baseline, the proportion of patients with CD4% ≥ 25% was lower in the TI group than in the control group (52.0% vs. 72.0%; P < 0.01), even among children restarting cART at least 6 months earlier (aRR = 0.5; 0.3-0.9; P = 0.03). CONCLUSIONS The risk of TI in clinical practice has decreased but remains high. In intent-to-treat analysis, TI was associated with a greater risk of subsequent immunosuppression, even after cART resumption.
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Prinapori R, Rosso R, Di Biagio A, Miletich F, Furfaro E, Taramasso L, Ginocchio F, Giacomet V, Nulvesu L, Sormani MP, Schiavetti I, Signori A, De Hoffer L, Viscoli C. Pharmacokinetics of lopinavir determined with an ELISA test in youths with perinatally acquired HIV. Indian J Pediatr 2014; 81:856-60. [PMID: 24014186 DOI: 10.1007/s12098-013-1198-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/24/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the plasma levels of lopinavir by enzyme-linked immunosorbent assay (ELISA) in a cohort of patients who were vertically infected with human immunodeficiency virus 1 (HIV). METHODS Plasma levels of lopinavir (Cmin) were determined by ELISA test in patients treated with lopinavir/ritonavir-based combined antiretroviral therapy who had achieved virological response after 4 wk of therapy. Reference lopinavir concentrations were Cmin 1-8 μg/mL. Correlation between lopinavir plasma concentration and continuous variables was evaluated by mean of Pearson correlation coefficient. Differences in lopinavir (LPV) concentration for binary categorical variables were assessed by Mann-Whitney test, while for variables with more than two categories Kruskal-Wallis test was used. RESULTS Thirty-four patients were enrolled; median age was 133 mo (15-265). The median lopinavir dose tested was 383.5 mg/kg (IQR: 266.6-400 mg/kg), with a median plasma concentration of 8.8 μg/mL (IQR: 5-14 μg/mL). Lopinavir Cmin was <1 μg/mL in only one sample (2.9 %), while 14 samples had Cmin between 1 and 8 μg/mL (41.2 %) and 19 (55.9 %) > 8 μg/mL. No significant correlations were found between plasma concentrations of lopinavir and the continuous variables considered in the study. A negative but, not completely significant, correlation was found between plasma drug concentration and body mass index (r = -0.29; p = 0.09). CONCLUSIONS The use of a simple and relatively cost-effective methodology might render therapeutic drug monitoring (TDM) appeal in the daily clinical practice.
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Affiliation(s)
- Roberta Prinapori
- Infectious Diseases Clinic, San Martino Hospital, University of Genoa, Genoa, Italy
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Dachew BA, Tesfahunegn TB, Birhanu AM. Adherence to highly active antiretroviral therapy and associated factors among children at the University of Gondar Hospital and Gondar Poly Clinic, Northwest Ethiopia: a cross-sectional institutional based study. BMC Public Health 2014; 14:875. [PMID: 25155293 PMCID: PMC4158084 DOI: 10.1186/1471-2458-14-875] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 08/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The efficacy of antiretroviral therapy (ART) in suppressing viral replication and delaying the progress of the acquired immunodeficiency syndrome (AIDS) is related to optimal adherence. Adherence is a challenge in all HIV infected people on ART. It is especially a concern in children because of factors relating to children such as age, disclosure status of HIV sero status, and understanding of the medication. This study assessed the level of adherence to highly active antiretroviral therapy and its associated factors among children in Gondar University Hospital and Gondar Poly Clinic, Northwest Ethiopia. METHODS Institutionally based cross-sectional study design was conducted from January-to March 2012. Simple random sampling technique was used to select study participants and a total of 342 study subjects were included in the study. Bivariate and multivariate logistic regressions were performed to identify associated factors with adherence to highly active antiretroviral therapy. Odds ratios with 95% confidence interval were computed to determine the level of significance. RESULTS The overall ART adherence among children was found to be 90.4%. Age of the child [AOR = 0.37 (95% CI: 0.31, 0.46)], disclosure of the child's HIV status to the child [AOR = 0.27 (95% CI: 0.24, 0.32)], and knowledge of caregivers about ART medication [AOR = 4.7 (95% CI (3.7, 5.6)], were independently associated with adherence. CONCLUSION Adherence rate to ART was found to be high. Disclosure of the child's HIV sero status to the child, the age of the child and the knowledge of the caregivers towards ART were factors associated with adherence.
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Affiliation(s)
- Berihun Assefa Dachew
- University of Gondar, College of medicine and Health science, Institute of public health, Department of Epidemiology and Bio-statistics, P,O, Box: 196, Gondar, Ethiopia.
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Eticha T, Berhane L. Caregiver-reported adherence to antiretroviral therapy among HIV infected children in Mekelle, Ethiopia. BMC Pediatr 2014; 14:114. [PMID: 24766911 PMCID: PMC4018187 DOI: 10.1186/1471-2431-14-114] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 04/22/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) in children is complicated may be because of many factors such as child characteristics, caregiver and family characteristics, regimen characteristics, etc. Therefore, it is important to identify factors associated with adherence in HIV infected children in order to reduce the risk of developing treatment failure or drug resistance through interventions. This survey was planned to find out the rate of adherence to ART and its associated factors among the children in Mekelle, Tigray region, Ethiopia. METHODS A cross-sectional survey was conducted in two hospitals in Mekelle: Ayder Referral Hospital and Mekelle Hospital, during the months of February to March 2013. A structured questionnaire was administered to caregivers to assess patient's adherence. RESULTS Out of a total of 193 patients, 83.4% as reported by caregivers were adherent to ART in the past seven days before the interview. On multivariate logistic regression model, it was found that the children whose caregivers were unmarried (AOR = 15.17, 95% CI: 3.36-68.43) and married (AOR = 3.54, 95% CI: 1.23-10.13) were more likely to adhere to their ART treatment than those whose caregivers were divorced/separated. Similarly, children whose caregivers' age groups of 25-34 (AOR = 22.27, 95% CI: 4.34-114.29) and 35-44 (AOR = 7.14, 95% CI: 1.65-30.95) were more likely to adhere than their counterparts. The major reasons reported by caregivers for missing medicines include: child being depressed (24.4%), drug side effects (16.3%), too many pills (15.5%) and difficulty in swallowing pills (13.3%). CONCLUSIONS The prevalence of adherence to ART among children was found to be high and comparable to that of other similar setups. Nevertheless, encouraging the fundamental role of caregivers is so significant to improve adherence among those who missed a dose or more and consequently treatment outcomes of children with HIV.
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Affiliation(s)
- Tadele Eticha
- Department of Pharmacy, College of Health Sciences, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia
| | - Lwam Berhane
- Department of Pharmacy, College of Health Sciences, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia
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Hagströmer O, Lundstedt L, Balcha TT, Björkman P. Decentralised paediatric HIV care in Ethiopia: a comparison between outcomes of patients managed in health centres and in a hospital clinic. Glob Health Action 2013; 6:22274. [PMID: 24219898 PMCID: PMC3825866 DOI: 10.3402/gha.v6i0.22274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 10/10/2013] [Accepted: 10/11/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In order to increase access to antiretroviral therapy (ART) in HIV-infected children, paediatric HIV care has been introduced in health centres in Ethiopia, where patients are managed by health professionals with limited training. OBJECTIVE To compare outcomes of paediatric HIV care in hospital and health centre clinics and to determine risk factors for death and loss to follow-up (LTFU). DESIGN Retrospective comparison of patient characteristics and outcomes among children managed in a public hospital and all five public health centres in the uptake area. RESULTS Among 1,960 patients (health centres 572, hospital clinic 1,388), 34% were lost to follow-up, 2% died, 14% were transferred out, and 46% remained in care. Children initiating ART in the hospital clinic had lower median CD4 cell counts (age <1 year: 575 vs. 1,183 cells/mm³, p=0.024; age 1-5 years: 370 vs. 598 cells/mm³, p<0.001; age >5 years: 186 vs. 259 cells/mm³, p<0.001), and a higher proportion were <1 year of age (22% vs. 15%, p=0.025). ART initiation rates and retention in care were similar between children managed in health centres and in the hospital clinic (36% vs. 37% and 47% vs. 46%, respectively). Among patients starting ART, mortality was associated with age <1 year [hazard ratio (HR) 12.0; 95% confidence interval (CI): 3.5, 41]. LTFU was associated with CD4 cell counts <350 cells/mm³ (HR 1.8; 95% CI: 1.2, 3.0), weight-for-age z-scores below -4 (HR 2.8; 95% CI: 1.4, 5.6), and age <5 years (1-5 years: HR 1.6; 95% CI: 1.0, 2.5; <1 year: HR 3.3; 95% CI: 1.6, 6.6). CONCLUSIONS Outcomes of HIV care were similar for Ethiopian children managed in a hospital clinic or in health centres. However, patients treated at the hospital clinic had characteristics of more advanced disease. Rates of LTFU were high in both types of health facility.
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Affiliation(s)
- Oskar Hagströmer
- Infectious Disease Research Unit, Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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Endayehu Y, Mekasha A, Daba F. The pattern of mucocutaneous disorders in HIV infected children attending care and treatment in Tikur Anbesa specialized hospital, Addis Ababa, Ethiopia. BMC DERMATOLOGY 2013; 13:12. [PMID: 24156274 PMCID: PMC4016538 DOI: 10.1186/1471-5945-13-12] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 10/22/2013] [Indexed: 11/29/2022]
Abstract
Background Children with HIV infection may develop a wide variety of infectious and inflammatory diseases of the skin. These disorders are often more severe and more difficult to treat than in the immunocompetent child. In some cases, disorders of the skin or mucous membranes may provide an early clue to the presence of pediatric HIV infection. Methods It is a descriptive cross-sectional study which was conducted at the pediatric infectious disease unit, department of pediatrics and child health, Tikur Anbesa specialized Hospital. Clinical information was collected using a questionnaire. The data was analyzed using SSPS 16.0 version. Chi-squared was utilized where appropriate and a p-value of less than 0.05 was considered statistically significant. Results Two hundred seventy HIV infected children were recruited in this study. Out of these females were 51.5% and males were 48.5%. Most of the children 196/270 (72.6%) were suffering from one or more mucocutanous disorders. The most prevalent mucocutanous disorders were infectious dermatosis. Overall, mucocutaneous disorders were more prevalent in advanced stages of HIV disease P < 0.001. Two or more mucocutanous disorders were found in moderate and sever immunosuppression. Seventy three percent of the HIV-infected children with mucocutaneous disorders were already on HAART. Conclusions The prevalence of mucocutanous disorders is high in HIV infected children. Advanced immunosuppression is highly associated with a wide spectrum of mucocutanous disorders.
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Affiliation(s)
- Yichalal Endayehu
- Department of Pediatrics and Child Health, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
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Biressaw S, Abegaz WE, Abebe M, Taye WA, Belay M. Adherence to Antiretroviral Therapy and associated factors among HIV infected children in Ethiopia: unannounced home-based pill count versus caregivers' report. BMC Pediatr 2013; 13:132. [PMID: 24229394 PMCID: PMC3766076 DOI: 10.1186/1471-2431-13-132] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 08/28/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The introduction of Antiretroviral Therapy (ART) has brought a remarkable reduction in HIV-related mortality and morbidity both in adults and children living with HIV/AIDS. Adherence to ART is the key to the successful treatment of patients as well as containment of drug resistance. Studies based on caregivers' report have shown that adherence to ART among children is generally good. However, subjective methods such as caregivers' report are known to overestimate the level of adherence. This study determined the rate of adherence and its predictors using unannounced home-based pill count and compared the result with caregivers' report in a tertiary referral hospital in Ethiopia. METHODS A cross-sectional study was conducted between December 1, 2011 and January 30, 2012. The study participants were 210 children on ART and their caregivers attending pediatric ART clinic of Tikur Anbessa Hospital (TAH), Addis Ababa University. Caregivers were interviewed at the ART clinic using a structured questionnaire. Then, unannounced home-based pill count was done 7 days after the interview. RESULTS Caregiver-reported adherence in the past 7 days prior to interview was 93.3%. Estimated adherence using unannounced home-based pill count was found, however, to be 34.8%. On multivariate logistic regression model, children with married [aOR = 7.85 (95% CI: 2.11,29.13)] and widowed/divorced [aOR = 7.14 (95% CI: 2.00,25.46)] caregivers, those who were not aware of their HIV sero-status [aOR = 2.35 (95% CI:1.09, 5.06)], and those with baseline WHO clinical stage III/IV [OR = 3.18 (95% CI: 1.21, 8.40] were more likely to adhere to their ART treatment. On the other hand, children on d4T/3Tc/EFV combination [OR = 0.10 (95% CI: 0.02, 0.53)] were less likely to adhere to their treatment. Caregivers' forgetfulness and child refusal to take medication were reported as the major reasons for missing doses. CONCLUSION The level of adherence based on unannounced home-based pill count was unacceptably low. Interventions are urgently needed to improve adherence to ART among children at TAH. Besides, a longitudinal study measuring adherence combined with clinical parameters (viral load and CD4 count) is needed to identify a simple and reliable measure of adherence in the study area.
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Affiliation(s)
- Silenat Biressaw
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, P,O, Box 1176, Addis Ababa, Ethiopia.
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Rolim de Holanda E, De Souza MA, Rolim de Holanda V, Josino dos Santos SM, Gimeniz Galvão MT, De Oliveira Lopes MV. Adherence to the Treatment of Children Living with HIV: A Conceptual Analysis. AQUICHAN 2012. [DOI: 10.5294/aqui.2012.12.3.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: Analizar el concepto de la adherencia al tratamiento de los niños que viven con el VIH, expresado en la literatura de la salud, haciendo la identificación de sus atributos esenciales, antecedentes y consecuencias. Método: método evolutivo de análisis de concepto propuesto por Rodgers para evaluar los 17 artículos que se centraron en el tema del estudio. Resultados: identificado como atributos esenciales que caracterizan el concepto. A raíz de la prescripción por el binomio niño-familia, la disponibilidad de formulaciones pediátricas, acompañamiento clínico y de laboratorio regulares, adecuación de los hábitos y toma de decisiones compartida entre el cuidador y el niño. Conclusiones: con base en los elementos identificados, se elaboró una definición consensuada en que se entiende la adherencia al tratamiento de los niños VIH positivos como un proceso de colaboración que va más allá de tomar los medicamentos, teniendo en cuenta el dinamismo, los aspectos de la familia, la vida cotidiana de los niños, la parte social, económica y estructural del fenómeno en estudio. Los hallazgos permiten una comprensión más amplia del concepto y ofrecer subsidios para la prestación de la atención integral dirigida a controlar la enfermedad y mejorar la calidad de vida. Se sugiere la formación de grupos multidisciplinarios dedicados a la realización de trabajos educativos sobre las dificultades en el cumplimiento, la promoción de un espacio de intercambio de experiencias y el desarrollo de estrategias de afrontamiento
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Wiens MO, MacLeod S, Musiime V, Ssenyonga M, Kizza R, Bakeera-Kitaka S, Odoi-Adome R, Ssali F. Adherence to antiretroviral therapy in HIV-positive adolescents in Uganda assessed by multiple methods: a prospective cohort study. Paediatr Drugs 2012; 14:331-5. [PMID: 22765225 DOI: 10.2165/11599280-000000000-00000] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND The effectiveness of traditional adherence measurements used in adolescent populations is difficult to assess. Antiretroviral (ARV) adherence research among adolescents living with HIV in resource-constrained countries is particularly challenging and little evidence is available. OBJECTIVES The primary objective of this study was to determine the feasibility of a large-scale, long-term study using electronic adherence monitoring in Uganda. The secondary objective was to compare accuracy of pill count (PC) and self-report (SR) adherence with electronic medication vials (eCAPs™). METHODS Adolescents receiving ARV therapy at the Joint Clinical Research Centre in Kampala, Uganda, were recruited. ARVs were dispensed in eCAPs™ for 1 year. Person-pill-days (PPDs) [1 day where adherence was measured for one medication in one patient] were calculated and a weighted paired t-test was used to compare the levels of adherence among subjects for three different adherence measurement methods. RESULTS Fifteen patients were included: 40% were female, mean age was 14 years, mean baseline CD4+ cell count was 244 cells/μL, and average treatment duration was 9 months at study entry. Overall, 4721 PPDs were observed. Some eCAPs™ required replacement during the study resulting in some data loss. Consent rate was high (94%) but was slow due to age limit cut-points. Overall adherence for SR was 99%, PC was 97% and eCAP™ was 88% (p<0.05 for all comparisons). 93%, 67% and 23% of patients had an adherence of greater than 95% as measured by SR, PC and eCAP™ methods, respectively. CONCLUSIONS A large-scale adherence study in Uganda would be feasible using a more robust electronic monitoring system. Adherence measurements produced by PCs and self-reporting methods appear to overestimate adherence measured electronically.
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Affiliation(s)
- Matthew O Wiens
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
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Bacha T, Tilahun B, Worku A. Predictors of treatment failure and time to detection and switching in HIV-infected Ethiopian children receiving first line anti-retroviral therapy. BMC Infect Dis 2012; 12:197. [PMID: 22916836 PMCID: PMC3507905 DOI: 10.1186/1471-2334-12-197] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 08/20/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The emergence of resistance to first line antiretroviral therapy (ART) regimen leads to the need for more expensive and less tolerable second line drugs. Hence, it is essential to identify and address factors associated with an increased probability of first line ART regimen failure. The objective of this article is to report on the predictors of first line ART regimen failure, the detection rate of ART regime failure, and the delay in switching to second line ART drugs. METHODS A retrospective cohort study was conducted from 2005 to 2011. All HIV infected children under the age of 15 who took first line ART for at least six months at the four major hospitals of Addis Ababa, Ethiopia were included. Data were collected, entered and analyzed using Epi info/ENA version 3.5.1 and SPSS version 16. The Cox proportional-hazard model was used to assess the predictors of first line ART failure. RESULTS Data of 1186 children were analyzed. Five hundred seventy seven (48.8%) were males with a mean age of 6.22 (SD = 3.10) years. Of the 167(14.1%) children who had treatment failure, 70 (5.9%) had only clinical failure, 79 (6.7%) had only immunologic failure, and 18 (1.5%) had both clinical and immunologic failure. Patients who had height for age in the third percentile or less at initiation of ART were found to have higher probability of ART treatment failure [Adjusted Hazard Ratio (AHR), 3.25 95% CI, 1.00-10.58]. Patients who were less than three years old [AHR, 1.85 95% CI, 1.24-2.76], chronic diarrhea after initiation of antiretroviral treatment [AHR, 3.44 95% CI, 1.37-8.62], ART drug substitution [AHR, 1.70 95% CI, 1.05-2.73] and base line CD4 count below 50 cells/mm3 [AHR, 2.30 95% CI, 1.28-4.14] were also found to be at higher risk of treatment failure. Of all the 167 first line ART failure cases, only 24 (14.4%) were switched to second line ART with a mean delay of 24 (SD = 11.67) months. The remaining 143 (85.6%) cases were diagnosed to have treatment failure retrospectively by the authors based on their records. Hence, they were not detected and these patients were not offered second line ARTs. CONCLUSIONS Having chronic malnutrition, low CD4 at base line, chronic diarrhea after initiation of first line ART, substitution of ART drugs and age less than 3 years old were found to be independent predictors of first line ART failure in children. Most of the first line ART failure cases were not detected early and those that were detected were not switched to second line drugs in a timely fashion. Children with the above risk factors should be closely monitored for a timely switch to second line highly active anti-retroviral therapy.
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Affiliation(s)
- Tigist Bacha
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Birkneh Tilahun
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
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Bhattacharya M, Dubey AP. Adherence to antiretroviral therapy and its correlates among HIV-infected children at an HIV clinic in New Delhi. ACTA ACUST UNITED AC 2012; 31:331-7. [PMID: 22041467 DOI: 10.1179/1465328111y.0000000031] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND With the introduction of antiretroviral therapy (ART), the mortality and morbidity of HIV/AIDS have decreased markedly. However, high adherence to ART (>95%) is necessary for a good therapeutic outcome. There is a paucity of data on paediatric adherence to ART and its correlates from developing countries, particularly India. AIM To determine the rate of adherence to ART in HIV-infected Indian children and the factors associated with adherence. METHODS A cross-sectional study was conducted at an ART clinic in New Delhi, north India. Caregivers of 90 children were interviewed using a pre-designed, structured questionnaire and checklist. The primary measure of adherence was 4-day caregiver's recall. Adherence rates were correlated with 3-monthly CD4 counts. RESULTS Mean (SD, range) adherence was 91·4% (12·3, 75-100%). Adherence was low (<95%) in 31 (34·4%) patients. On multivariate logistic regression analysis, increasing time since ART initiation (OR 1·08, 95% CI 1·02-1·13), low caregiver educational status (OR 4·19, 95% CI 1·37-10·88), orphanhood (OR 3·57, 95% CI 1·13-9·25), efavirenz-based ART regimens (OR 3·65, 95% CI 1·05-10·69) and female gender (OR 3·15, 95% CI 1·03-7·68) were associated with lower adherence. The rise in CD4 count after ART initiation was more marked in the high adherence group, with the difference in the two groups becoming statistically significant after 6 months of ART (median CD4 count 698 vs 355, p=0·016). CONCLUSIONS It is possible to achieve high adherence to ART in a resource-limited setting. Caregiver recall is a reliable and inexpensive tool for measuring adherence. Paediatric adherence to ART is influenced by numerous factors and larger studies are needed to address the issue in India.
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Affiliation(s)
- M Bhattacharya
- Department of Paediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
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Shargie MB, Eek F, Abaychew A. Prophylactic treatment uptake and compliance with recommended follow up among HIV exposed infants: a retrospective study in Addis Ababa, Ethiopia. BMC Res Notes 2011; 4:563. [PMID: 22201727 PMCID: PMC3260152 DOI: 10.1186/1756-0500-4-563] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 12/27/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children are being infected by HIV/AIDS mainly through mother-to-child transmission. In Ethiopia currently more than 135,000 children are living with HIV/AIDS. The aim of this study was to describe the pattern of ARV uptake after birth, co-trimoxazole prophylaxis and follow up compliance, and to examine which factors are associated with the intervention outcome. METHODS A retrospective quantitative study design was used for data collection through two hospitals. All infants who were delivered by HIV infected mothers between October 2008 and August 2009 were included and information regarding treatment adherence during their first 6 months of age was collected. FINDINGS 118 HIV exposed infant-mother pairs were included in the study. 107 (90.7%) infants received ARV prophylaxis at birth. Sixty six (56%) of the infants were found to be adherent to co-trimoxazole prophylactic treatment. The majority (n = 110(93.2%)) of infants were tested HIV negative with DNA/PCR HIV test at the age of sixth weeks. Infants who took ARV prophylaxis at birth were found to be more likely to adhere with co-trimoxazole treatment: [OR = 9.43(95% CI: 1.22, 72.9)]. Similarly, infants whose mothers had been enrolled for HIV/ART care in the same facility [OR = 14(95% CI: 2.6, 75.4)], and children whose fathers were tested and known to be HIV positive [OR = 3.0(95% CI: 1.0, 9.0)] were more likely to adhere than their counterparts. Infants feeding practice was also significantly associated with adherence χ2 -test, p < 0.01. CONCLUSION The proportion of ARV uptake at birth among HIV exposed infants were found to be high compared to other similar settings. Mother-infant pair enrolment in the same facility and the infant's father being tested and knew their HIV result were major predictors of infants adhering to treatment and follow up. However, large numbers of infants were lost to follow up.
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Affiliation(s)
- Mulatu Biru Shargie
- Master's Programme in Public Health Faculty of Medicine Lund University Malmö, Sweden.
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Valdivia Vadell C, Soler-Palacín P, Martín-Nalda A, Cabañas Poy M, Clemente Bautista S, Espiau Guarner M, Figueras Nadal C. Evaluación de un programa de valoración de adherencia al tratamiento antirretroviral. An Pediatr (Barc) 2011; 75:380-95. [DOI: 10.1016/j.anpedi.2011.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/16/2011] [Accepted: 05/17/2011] [Indexed: 11/28/2022] Open
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Biadgilign S, Reda AA, Deribew A, Amberbir A, Belachew T, Tiyou A, Deribe K. Knowledge and attitudes of caregivers of HIV-infected children toward antiretroviral treatment in Ethiopia. PATIENT EDUCATION AND COUNSELING 2011; 85:e89-e94. [PMID: 21429696 DOI: 10.1016/j.pec.2011.02.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2010] [Revised: 01/16/2011] [Accepted: 02/14/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To determine the knowledge and attitude of caregivers of HIV-infected children taking antiretroviral therapy (ART) in Ethiopia. METHODS A total of 390 caregivers of HIV infected children were surveyed in selected ART units in Addis Ababa. Data was collected using a pretested and structured questionnaire. RESULTS Seventy two (18.5%) of the caregivers believed that HIV can be cured by taking antiretroviral (ARV) medications. Three hundred and nineteen (81.8%) participants reported that taking ARVs incorrectly would bring about resistance to the drug. Three hundred and eighty (97.4%) caregivers had favorable attitude toward administration of ARV medication to children. Almost all of the caregivers (379, 97.2%) reported to have had enough privacy in their consultation with the doctor or nurse. Having enough privacy during consultation (OR 7.18; 95% CI 1.24-41.6) and knowledge that HIV cannot be cured by ART (OR 3.89; 95% CI 1.05-14.4) were associated with favorable attitude toward ART administration. CONCLUSION The majority of the caregivers had good knowledge and favorable attitude toward administration of ARV medication to children. However some misconceptions such as beliefs that ART cures HIV/AIDS exist. PRACTICAL IMPLICATIONS Health education efforts should continue focusing on the objective of ART treatment and toward dispelling the prevailing misconceptions.
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Affiliation(s)
- Sibhatu Biadgilign
- Department of Epidemiology and Biostatistics, Jimma University, College of Public Health and Medical Science, Ethiopia, Addis Ababa, Ethiopia.
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