<p>Differential Self-Reported Determinants to Antiretroviral Therapy Adherence: Findings from Caregivers of Children Under Five Years Living with Human Immunodeficiency Virus Infection Attending Al-Sabah Hospital, South Sudan</p>

Abstract

This study explored the caregivers' self-reported determinants of antiretroviral therapy (ART) adherence among children under five years living with human immunodeficiency virus (HIV) infection attending Al-Sabah Hospital, South Sudan. Methods: A cross-sectional study of 126 caregivers of HIV-infected children under five years was conducted at Al-Sabah Hospital, South Sudan. Data were collected using an intervieweradministered questionnaire. The self-reported adherence was measured as a binary variable using binary logistic regression. Only variables that were significant at bivariate analysis were analyzed at multivariate level and interpreted using the odds ratios (p< 0.05). Results: Out of 126 caregivers with HIV-infected children, 38 (30.2%) did not adhere to ART. Of the proportion that adhered to ART (88, 69.8%), 49 (55.7%) were male. Most of the children (52, 59.1%) were above two years, but under five years. Fifty (56.8%) of those who adhered had completed 3 months on ART, and the majority were at WHO stage-1 of HIV infection. Analysis of the determinants indicated that children's duration on ART (p=0.001), type of ART regimen (single, double or triple therapy) (p=0.065), type of work done by the caregiver to earn a living (p-value 0.003), time a child was initiated on ART (p=0.002), caregiver-child relationship (p=0.002), caregiver-spousal support (p=0.019), type of support obtained whether monetary or not (p=0.000), when the child was started on ART (p=0.004), the person administering ART (p=0.010), the type of ARVs administered (p=0.001), the caregiver detecting ART side effects (p=0.000), types of adverse effects suffered by the child (p=0.043), time of receiving ART (p=0.047), use of western medicine (p=0.043), healthcare cadre (p=0.002), the kind of attention the healthcare provider offered (p=0.015), and improvements in quality of HIV services (p=0.001) were significantly associated with ART adherence. Conclusion: The study findings indicated that ART adherence among HIV-infected children under five years was suboptimal. This will necessitate continuous engagement and education of caregivers on the prominence of adhering to ART.

Adherence to Antiretroviral Therapy and Associated Factors Among Children Living With HIV in East Wallaga Zone Public Health Institutions, Ethiopia

“…14 However, it was less than different researches done in Ethiopia which were 90% to 94%, 10-12 91% in Nigeria, 8 and 89.1% in South Africa. 7 However, the current study was higher than studies conducted in Fiche, Ethiopia which was 64.2%, 9 66.7% in Ambo (Ethiopia), 15 79.8% in South Sudan, 4 42.7% in Uganda, 16 and 47.5% in Ghana. 6 The discrepancies might be due to differences in the measurement of adherence assessment used and differences in clinical settings.…”

“…2 Adherence greater than 95% will ensure a good virological response and prevent the emergence of viral resistance, increase the success of the ART program, reduce HIV/AIDS-related disease, improves life expectancy and quality of life. 3,4 Therefore, efforts to improve adherence levels are likely to result in improved health outcomes. Adherence to the antiretroviral drug in children is problematic due to multiple factors which include high pill burden, child age, poor palatability, side effects, longterm toxicity, caregiver relationship with child, forgetfulness, and caregiver knowledge of their HIV status.…”

“…Adherence to the antiretroviral drug in children is problematic due to multiple factors which include high pill burden, child age, poor palatability, side effects, longterm toxicity, caregiver relationship with child, forgetfulness, and caregiver knowledge of their HIV status. 5 The study conducted in the Africa region suggests that 47.5% in Ghana, 6 79.8% in South Sudan, 4 79% in Uganda, 5 89.1% in South Africa, 7 and 91% in Nigeria 8 of ART users achieve optimal adherence. Moreover, a previous study conducted in Ethiopia showed that 79.1% in 64.2% to 94% children were adherent to ART which was lower than adherent recommended by World Health Organization (WHO).…”

“…The study conducted in the Africa region suggests that 47.5% in Ghana, 6 79.8% in South Sudan, 4 79% in Uganda, 5 89.1% in South Africa, 7 and 91% in Nigeria 8 of ART users achieve optimal adherence. Moreover, a previous study conducted in Ethiopia showed that 79.1% in 64.2% to 94% children were adherent to ART which was lower than adherent recommended by World Health Organization (WHO).…”

Factors Associated with Retention in HIV Care Among HIV-Positive Adolescents in Public Antiretroviral Therapy Clinics in Ibanda District, Rural South Western Uganda

“…or comorbidities improves the quality of life and ART retention. 22,23 Additionally, 100% retention was observed among those that disclosed their HIV status (p = 0.292). As previously explored, disclosure of ALHIV has strong empirical support.…”