A comprehensive programme to strengthen adherence to antiretroviral drug therapy and achieve virological control in HIV infected children in Thailand

Association of Antiretroviral and Clinic Adherence With Orphan Status Among HIV-Infected Children in Western Kenya

“…These findings differ from previous studies done in smaller cohorts within resource-limited settings, in which orphan status was not significantly associated with ART nonadherence. 13,16,33,34 These findings also differ from results of studies done in the United States and Europe where having a foster parent or nonbiological caregiver is associated with a higher rate of ART adherence. [45][46][47] However, having a foster parent or nonbiological caregiver in the United States or Europe may reflect a situation in which a parent is unable to provide adequate care, rather than a situation where the parent is dead.…”

“…25,27,[30][31][32] In some studies from resource-limited settings, orphan status has been associated with ART nonadherence, 20,22 whereas other studies have not found a significant correlation between nonadherence and orphan status. 13,16,33,34 The particular orphan care system may play a role; one study suggests that orphans with institutional caregivers have better adherence than those with noninstitutional caregivers. 22 The variable effects of orphan status on dimensions of HIV care and outcomes merit further examination.…”

Successful clinical outcomes following decentralization of tertiary paediatric HIV care to a community‐based paediatric antiretroviral treatment network, Chiangrai, Thailand, 2002 to 2008

“…The mortality rate of 4.1/100 child-years of follow-up with most deaths occurring within the first three months of treatment was comparable to other paediatric cohorts in resource-limited countries [8,9,27,28Á30], as was the association between advanced HIV-related disease and mortality [9,20,23,24]. These findings underscore the importance of early identification of HIV-infected children and timely initiation of ART.…”

“…Although comparison across studies should be done with caution, this study reported better adherence than most paediatric treatment programs, with several studies reporting 50 to 80% adherence [ 21 – 23 ]. The intensity and support given to patients and caregivers in this program may explain the high level of adherence and suggest that multiple approaches combining educational and behavioural components are useful in achieving desirable adherence levels [ 24 ].…”

Factors Sustaining Pediatric Adherence to Antiretroviral Therapy in Western Kenya

“…Other studies from resource-limited settings suggest that parents' social class (Mukhtar-Yola et al, 2006) and available social support (Nabukeera-Barungi et al, 2007) are not significantly associated with adherence. Orphan status has also been associated with ART nonadherence in some studies (Cupsa et al, 2000;Vreeman, Wiehe, Ayaya, et al, 2008;Wachholz & Ferreira, 2007), but not in others (Hansudewechakul, Jourdain, Plangraun, & Team, 2006;Nabukeera-Barungi et al, 2007;Nyandiko et al, 2006;Safreed-Harmon et al, 2007), and this association differs by type of caregiver (Wachholz & Ferreira, 2007). The existing literature argues that the child's socioeconomic context plays a key role in adherence, but differences in the findings suggest we do not understand how these factors interact or which factors should be measured (Sankar, Golin, Simoni, Luborsky, & Pearson, 2006).…”