Adherence among children and young people living with HIV/AIDS: A systematic review of medication and comprehensive interventions

Arrivillaga, Marcela; Martucci, Vanessa; Hoyos, Paula Andrea; Arango, Andrea

doi:10.1080/17450128.2013.764031

Cited by 16 publications

(11 citation statements)

References 21 publications

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“…Adherence to ART is one of the important factors of treatment outcome. Poor adherence may result in a non-suppressed viral load, leading to opportunistic infections, drug resistance and ultimately mortality [20]. This is strongly supported by different studies across the world.…”

Section: Discussionmentioning

confidence: 99%

Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

et al. 2019

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Background Human immunodeficiency virus (HIV) infected children represent a very vulnerable population for anti-retroviral therapy (ART) drug resistance. As a global target, 90% of patients receiving ART should have HIV-RNA viral suppression. A threshold of > 1000 RNA copies/ml is used to define non-suppressed viral load. If it is confirmed in the laboratory, adherence should be addressed and should be followed by the switch to second-line ART. Therefore, the aim of this study was to assess the rate of viral load suppression among children tested at the Amhara Public Health Institute (APHI), Bahir Dar. Methods Institutional based cross-sectional study design was conducted from July 01, 2017 to June 30, 2018, in children under the age of 15 years. Socio-demographic, clinical and HIV1RNA viral load data were collected from the excel database. The data were analyzed in SPSS 20.0 statistical software. Results A total of 1567 children, age ranged from one to 14 years, were tested for HIV viral load. Of which, about 54% were males. Children were treated using nevirapine-based (76.7%), efavirenz-based (21.8%) and protease inhibitor-based (1.5%) anti-retroviral drugs. Non-suppressed HIV viral load was found in 28.3% of the participants. High viral load (> 1000 cp/ml) were found in 24% of the children below the age of five years. Children on nevirapine-based treatment had about two times more non-suppressed viral load (Adjusted odds ratio [AOR]: 1.90; 95%CI: 1.41–2.56; P < 0.001) compared to those who had efavirenz-based treatment. However, adherence (P: 0.204) was not associated with non-suppressed viral load. Conclusions There was a high rate of non-suppressed HIV viral load among children tested at APHI. Specifically, the odds of having a non-suppressed viral load was higher in NVP based treatment users. Hence, comprehensive management and follow up of children on ART, and testing for resistance as well as viral load could help to reduce the problem in advance.

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Section: Discussionmentioning

confidence: 99%

Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

et al. 2019

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“…Poor adherence may result in an unsuppressed viral load, leading to opportunistic infections, drug resistance and ultimately mortality (Arrivillaga, Martucci, Hoyos, & Arango, 2013 ). With limited ART drug options available in South Africa (Davies et al, 2011 ), adherence to first-line medication is key to ensuring optimal and prolonged treatment benefits.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective

2014

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Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance. HIV-infected children, especially those 5 years and under, are dependent on a caregiver to adhere to ART. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. We conducted 9 interviews and 3 focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using Atlas.ti version 7. Results were interpreted through the lens of Bronfenbrenner’s Ecological Systems Theory (EST). We found that at the micro-level, palatability of medication and large volumes of medication were problematic for young children. Characteristics of the caregiver including absent mothers, grandmothers as caregivers, and denial of HIV amongst fathers were themes related to the micro-system. Language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence in the meso-system. Adherence counselling and training were the most problematic features in the exo-system. In the macro-system, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. Increased supervision and regular training amongst lay adherence counsellors are needed, as well as regular monitoring of the persons attending the clinic on the child’s behalf.

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“…ALHIV must additionally confront the challenges of adhering to cART and a schedule of routine medical appointments, disclosing the diagnosis to friends and romantic partners, and HIV-related stigma [5]. These hurdles often manifest in adverse social and medical consequences including a greater difficulty managing relationships, [5–7] lower cART adherence, [8] and higher mortality [9, 10].…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, effective evidence-based interventions for this group are lacking, [5] especially in Latin America where half of new infections occur among adolescents and young adults [13]. Two systematic reviews of cART adherence interventions for ALHIV identified no interventions in Latin America [8, 14]. Only 2% of ALHIV in a recent global cohort analysis were from countries of Latin America and the Caribbean [15].…”

Section: Introductionmentioning

confidence: 99%

Understanding health-related behavior among adolescents living with HIV in Lima, Peru

et al. 2019

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BackgroundThe global HIV burden among adolescents ages 10–19 is growing. This population concurrently confronts the multifaceted challenges of adolescence and living with HIV. With the goal of informing future interventions tailored to this group, we assessed sexual activity, HIV diagnosis disclosure, combination antiretroviral therapy (cART) adherence, and drug use among adolescents living with HIV (ALHIV) in Lima, Peru.MethodsAdolescents at risk or with a history of suboptimal cART adherence completed a self-administered, health behaviors survey and participated in support group sessions, which were audio recorded and used as a qualitative data source. Additionally, we conducted in-depth interviews with caregivers and care providers of ALHIV. Thematic content analysis was performed on the group transcripts and in-depth interviews and integrated with data from the survey to describe adolescents’ health related behaviors.ResultsWe enrolled 34 ALHIV, of which 32 (14 male, 18 female, median age 14.5 years) completed the health behavior survey. Nine (28%) adolescents reported prior sexual intercourse, a minority of whom (44%) reported using a condom. cART adherence was highest in the 10–12 age group with 89% reporting ≤2 missed doses in the last month, compared to 36% in adolescents 13 years or older. Over 80% of adolescents had never disclosed their HIV status to a friend or romantic partner. Adolescents, caregivers, and health service providers described sexual health misinformation and difficulty having conversations about sexual health and HIV.ConclusionsIn this group of ALHIV, adherence to cART declined with age and condom use among sexually active adolescents was low. Multifactorial interventions addressing sexual health, gaps in HIV-related knowledge, and management of disclosure and romantic relationships are urgently needed for this population.

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Adherence among children and young people living with HIV/AIDS: A systematic review of medication and comprehensive interventions

Cited by 16 publications

References 21 publications

Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

Viral suppression rate among children tested for HIV viral load at the Amhara Public Health Institute, Bahir Dar, Ethiopia

Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective

Understanding health-related behavior among adolescents living with HIV in Lima, Peru

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