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

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.

Predictors of Suboptimal Adherence Among Children on Antiretroviral Therapy in Southern Ethiopia: A Multicenter Retrospective Follow-Up Study

“…Therefore, children whose HIV sero-status was disclosed had 2.46 times higher odds of suboptimal adherence when compared to their counterparts. This is consistent with studies conducted in Uganda [32], Ethiopia [27,33], and on the other hand, the report from the current study contradicts a study done in Tikur Anbessa Hospital, Ethiopia [42] that states that HIV-positive children who were not aware of their HIV sero-status were more likely to adhere. Children who are not aware of their HIV status may not grasp the rationale for taking drugs and may become resistant to them since they do not understand why they take medicine while appearing to be well.…”

“…This finding is lower than studies conducted in Dar es Salaam [14] and Northern Tanzania [30] which reported a magnitude of 40% and 75.4%, respectively. The result of this study is in line with the studies conducted in New Delhi [31] (34.4%) Uganda [32] (28.05%) Gondar in Ethiopia [33] (31.9%) and Ambo in Ethiopia [34] (33.3%). On the contrary, the magnitude of suboptimal adherence determined by this study was reported to be higher than previous studies conducted in South India [35] (9.1%) and Nigeria [36] (14%).…”

Early Effects of Scaling Up Dolutegravir-Based ARV Regimens Among Children Living with HIV in Malawi

“…Despite improved palatability and once-daily dosing of pDTG-based regimens, ART adherence 6 months post-DTG transition was low, with only about half the patients having good adherence to ARVs, similar to study findings of children on NNRTI- and PI-based regimens from Uganda, Kenya, and Congo [ 19 – 21 ]. ART adherence was better in infants than in older children and patients whose guardians were biological parents than others, similar to a study in Ethiopia that found an association between non-biological caretakers and poor adherence among CLHIV [ 22 ]. In our study, good adherence to ART was associated with VS, similar to studies in Vietnam, Uganda, and Thailand, which have demonstrated an increased likelihood of viral non-suppression in those with poor adherence [ 23 – 25 ].…”

High prevalence of low-level viremia among infants initiated on antiretroviral drugs following mother-to-child transmission of HIV

“…Although some babies were enrolled in the study after ART initiation, the viral loads did not signi cantly differ between the naïve group and the treatment group because they were enrolled within two months of treatment initiation. Viral nonsuppression over time in pediatric patients is a major challenge that has been widely documented [19][20][21][22][23][24][25][26]. Sixty-ve percent of the babies had decreased to less than 1000 copies/ml by six months and 74% by twelve months in the study.…”