Adherence to antiretroviral therapy among children receiving therapy in a resource-poor setting

Background

Adherence to antiretroviral therapy (ART) is critical to the success of care and treatment initiatives. Yet adherence is a huge challenge for adults and it is even more difficult with children. The protocol objective was to establish the level of antiretroviral therapy adherence, factors that hinder or promote adherence, and the role of psychosocial factors in adherence among children receiving therapy in the DarDar pediatric program (DPP) in Dar es Salaam. The study was intended to help DPP formulate strategies that can be employed to improve current and future ART programs so as to optimize overall therapeutic goals.

Methods

The study was a cross-sectional survey in which all patients who met criteria were included. A total of 100 children and caretakers were interviewed. Interviewer-administered questionnaires to collect quantitative data and qualitative data were collected through in-depth interviews and focus group discussions of participants at DPP.

Summary of results

The mean adherence level was 97.5%. Majority of participants (65%) reported being >95% adherent to therapy, with only 25% being 100% adherent. There was a statistically significant relationship between adherence and level of education of caretaker, adherence and attitude towards ART, adherence and stigma. Factors that were barriers to ART adherence included unpleasant side-effects of drugs, bad taste and plenty in number, child's lack of understanding, and poor social economic support. Participants perceived that good understanding of the importance to adhere, use of reminder aids and social economic support from support groups, family members and health care workers were key in facilitating adherence.

Conclusion

The levels of adherence in children receiving ART are comparable to levels in resource-rich settings. It is possible for patients to achieve near perfect levels of adherence with formulations of fixed dose combinations for pediatrics, thorough counseling, use of reminders, tailoring the regime to the child's life style, and addressing key issues related to side-effects.