M Bhattacharya1, A P Dubey. 1. Department of Paediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. drmalvikab@gmail.com
Abstract
BACKGROUND: With the introduction of antiretroviral therapy (ART), the mortality and morbidity of HIV/AIDS have decreased markedly. However, high adherence to ART (>95%) is necessary for a good therapeutic outcome. There is a paucity of data on paediatric adherence to ART and its correlates from developing countries, particularly India. AIM: To determine the rate of adherence to ART in HIV-infected Indian children and the factors associated with adherence. METHODS: A cross-sectional study was conducted at an ART clinic in New Delhi, north India. Caregivers of 90 children were interviewed using a pre-designed, structured questionnaire and checklist. The primary measure of adherence was 4-day caregiver's recall. Adherence rates were correlated with 3-monthly CD4 counts. RESULTS: Mean (SD, range) adherence was 91·4% (12·3, 75-100%). Adherence was low (<95%) in 31 (34·4%) patients. On multivariate logistic regression analysis, increasing time since ART initiation (OR 1·08, 95% CI 1·02-1·13), low caregiver educational status (OR 4·19, 95% CI 1·37-10·88), orphanhood (OR 3·57, 95% CI 1·13-9·25), efavirenz-based ART regimens (OR 3·65, 95% CI 1·05-10·69) and female gender (OR 3·15, 95% CI 1·03-7·68) were associated with lower adherence. The rise in CD4 count after ART initiation was more marked in the high adherence group, with the difference in the two groups becoming statistically significant after 6 months of ART (median CD4 count 698 vs 355, p=0·016). CONCLUSIONS: It is possible to achieve high adherence to ART in a resource-limited setting. Caregiver recall is a reliable and inexpensive tool for measuring adherence. Paediatric adherence to ART is influenced by numerous factors and larger studies are needed to address the issue in India.
BACKGROUND: With the introduction of antiretroviral therapy (ART), the mortality and morbidity of HIV/AIDS have decreased markedly. However, high adherence to ART (>95%) is necessary for a good therapeutic outcome. There is a paucity of data on paediatric adherence to ART and its correlates from developing countries, particularly India. AIM: To determine the rate of adherence to ART in HIV-infected Indian children and the factors associated with adherence. METHODS: A cross-sectional study was conducted at an ART clinic in New Delhi, north India. Caregivers of 90 children were interviewed using a pre-designed, structured questionnaire and checklist. The primary measure of adherence was 4-day caregiver's recall. Adherence rates were correlated with 3-monthly CD4 counts. RESULTS: Mean (SD, range) adherence was 91·4% (12·3, 75-100%). Adherence was low (<95%) in 31 (34·4%) patients. On multivariate logistic regression analysis, increasing time since ART initiation (OR 1·08, 95% CI 1·02-1·13), low caregiver educational status (OR 4·19, 95% CI 1·37-10·88), orphanhood (OR 3·57, 95% CI 1·13-9·25), efavirenz-based ART regimens (OR 3·65, 95% CI 1·05-10·69) and female gender (OR 3·15, 95% CI 1·03-7·68) were associated with lower adherence. The rise in CD4 count after ART initiation was more marked in the high adherence group, with the difference in the two groups becoming statistically significant after 6 months of ART (median CD4 count 698 vs 355, p=0·016). CONCLUSIONS: It is possible to achieve high adherence to ART in a resource-limited setting. Caregiver recall is a reliable and inexpensive tool for measuring adherence. Paediatric adherence to ART is influenced by numerous factors and larger studies are needed to address the issue in India.
Authors: Peter K Olds; Julius P Kiwanuka; Denis Nansera; Yong Huang; Peter Bacchetti; Chengshi Jin; Monica Gandhi; Jessica E Haberer Journal: AIDS Care Date: 2014-12-06
Authors: Augustine O Ebonyi; Emeka U Ejeliogu; Sylvanus E Okpe; David D Shwe; Esther S Yiltok; Martha O Ochoga; Stephen Oguche Journal: Niger Med J Date: 2015 Jan-Feb
Authors: Rachel C Vreeman; Samuel O Ayaya; Beverly S Musick; Constantin T Yiannoutsos; Craig R Cohen; Denis Nash; Deo Wabwire; Kara Wools-Kaloustian; Sarah E Wiehe Journal: PLoS One Date: 2018-02-21 Impact factor: 3.240
Authors: Tetyana L Vasylyeva; Ruchi Singh; Christopher Sheehan; Sudha P Chennasamudram; Anne P Hernandez Journal: PLoS One Date: 2013-07-18 Impact factor: 3.240
Authors: Amos Haki Nsheha; Dorothy Elizabeth Dow; Gabriel Erick Kapanda; Bernardus Carolus Hamel; Levina January Msuya Journal: Pan Afr Med J Date: 2014-03-28