Factors influencing adherence to paediatric antiretroviral therapy in Portharcourt, South- South Nigeria

Abstract

IntroductionThe efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patient's adherence. Adherence in children poses peculiar challenges. The aim of the study was to determine the adherence level and factors influencing adherence among HIV-infected children and adolescents in University of Port Harcourt Teaching Hospital, Nigeria.MethodsA cross-sectional survey of HIV-infected children and adolescents on ART using self-report by the caregiver/child in the past one month.ResultsA total of 213 caregivers and their children were interviewed. A hundred and sixty-two (76.1%) had adherence rates ≥95%. Only 126 (59.2%) were completely (100%) adherent. The commonest caregiver-related factors for missing doses were forgetfulness 48(55.2%), travelled 22(25.3%) and drugs finished 16(18.4%), while the child-related factors were refused drugs 10(11.5%), slept 8(9.2%), and vomited 8(9.2%). Sixty-eight (31.9%) caregivers reported missing clinic visit and reasons given were travelled 18(26.5%), caregiver ill 12(17.6%) and family problems 9(13.2%). Predictors of poor adherence include mother as the primary caregiver (OR 3.32; 95%CI, 1.33-8.67), younger than 5years (OR 2.62; 95%CI, 1.30-5.31) and presence of a co-morbidity (OR 3.97; 95%CI, 1.92-8.33). Having a medication reminder strategy (OR 6.34; 95%CI, 3.04-13.31), regular clinic visits (OR 8.55; 95%CI 4.01-18.45) and status disclosure (p = 0.008) predicted a better adherence. The caregiver's age (p= 0.11), education (p = 0.86), socioeconomic status (p = 0.89), gender of the child (p = 0.84), type of ART (p = 0.2) and duration of ART (1.0) did not significantly affect adherence.ConclusionAdherence is still suboptimal. Since barriers to Paediatric ART adherence are largely caregiver-dependent, identifying and addressing these barriers in each caregiver-child pair will improve adherence and patient outcome.

Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia

“…The use of treatment reminders was associated with better adherence while the use of PI-based regimens predicted poorer adherence. The adherence rate in the current study is better than those reported from several low, middle and high income countries (Bhattacharya & Dubey, 2011;Kim, Gerver, Fidler, & Ward, 2014;Nyogea et al, 2015;Reda & Biadgilign, 2012;Ugwu & Eneh, 2013). …”

Magnitude and predictors of antiretroviral treatment failure among HIV-infected children in Fiche and Kuyu hospitals, Oromia region, Ethiopia: a retrospective cohort study

“…In this study, patient who had suboptimal adherence to their treatment had 4.85 times more risk of developing treatment failure which mirrors with other studies conducted in Nigeria, Tanzania, and Ethiopia (Ramadhani et al. 2007; Ugwu and Eneh 2013; Yimer and Yalew 2015). Another study in the public facility revealed that the risk factors for treatment failure include nonadherence and missed appointments (Gregory et al.…”

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

“…Adherence in adolescents has been reported to be poorer than in younger children, and older adults in both resourced rich and limited settings [18]. Reasons include adolescents' risk taking behavior, the stage of development when thought and reasoning is not fully developed, and regimen fatigue [18,38]. As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38].…”

“…Reasons include adolescents' risk taking behavior, the stage of development when thought and reasoning is not fully developed, and regimen fatigue [18,38]. As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38]. Some studies have reported adherence rates for long term prescription medications to be between 50-75% [18,19].…”