The Predictors of Adherence to Antiretroviral Therapy in Hiv Positive Children in Enugu State

Abstract

Antiretroviral therapy (ART) has been used to improve morbidity and mortality of the HIV positive patients . Antiretroviral therapy first line drugs comprise Nevirapine, Lamivudine, Efavirenz and Zidovudine. However, an excellent therapeutic outcome with ART requires > 95% adherence. The purpose of this study was to determine the predictors of adherence to ART among HIV -infected Children in Enugu State. A prospective study for four months between the periods of March to June 2009 was done among HIV positive children in the University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu. The adherence was measured using medication return in a bimonthly appointment and structured self administered pre-tested questionaire. Adherence was defined as no missed dose in the last three days. The CD 4 Count was also measured to correlate adherence to ART. The effects of factors such as level of education, type of caregiver, duration on therapy, proper education of caregiver, method of passing information, regularity of education and support from health professionals on adherence were done. Other factors like stigmatization in the home environment, prevalence of adverse effects and WHO clinical staging in relation to adherence were also carried out. The adherence level measured by self reporting was 69% (58 /84 ) and was not significantly higher for children in under 60 months compared to children above 60 months using increase weight gain as an indicator. Children of 120-143 months had the highest percent frequency and 57.1 % were male. The most frequent duration on ART was 0-11months (range 0->36months). The measured medication return of >90 % was 79 % in Nevirapine drug. Mean CD4 count available at initial contact for under 60 months Was reduced from 746.18 ± 626 .24 cells per pi to 572.22 ±521.25 cells per IJ I. The measured adherence did not correlate with reduced CD4 count, the biomedical marker in predicting adherence to antiretroviral therapy in children. Factors such as level of education, type of caregiver, duration on therapy, proper education of caregiver, method of passing information, regularity of education and support from health professionals on adherence investigated were found not to relate statistically significantly with adherence to ART. Non adherence was observed to increase with missed clinic appointments. The study revealed that adherence level of HIV positive children was 69 %.The proper education of caregiver and other factors did not show significant relationship with adherence. It was recommended that adherence support workers be set up to maintain the effectiveness of ART by doing follow up visits to see if the patients are taking their medications correctly and also maintaining a balanced diet.