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Adherence to antiretroviral therapy among HIV infected children measured by caretaker report, medication return, and drug level in Dar Es Salaam, Tanzania.
- Source :
-
BMC pediatrics [BMC Pediatr] 2013 Jun 15; Vol. 13, pp. 95. Date of Electronic Publication: 2013 Jun 15. - Publication Year :
- 2013
-
Abstract
- Background: Adherence to antiretroviral drugs in the treatment of paediatric HIV infection is complicated because of many factors including stigma and drug intake logistics. It is therefore important to identify children with non-adherence in order to intervene before they become at risk of developing treatment failure or drug resistance. The aim of this study was to determine the level of adherence to antiretroviral therapy (ART), measured by caretaker report, medication return and nevirapine plasma concentration. In addition, the association between level of adherence and patient's immune status was compared across the three methods of measuring adherence.<br />Methods: This was a descriptive cross-sectional study involving HIV infected children aged 2-14 years, on nevirapine- based antiretroviral treatment for at least six months, attending care and treatment clinic in three municipal hospitals in Dar- Es- Salaam City. Eligible patients and their accompanying caretakers were consecutively enrolled after obtaining written informed consent. Structured questionnaires were administered to caretakers to assess patient's adherence by caretaker report and medication return whereas a single blood sample for CD4 cell count/percent and determination of nevirapine plasma concentration was taken from patients on the day of assessment.<br />Results: A total of 300 patients and accompanying caretakers were enrolled and the mean patient age (SD) was 8 (3) years. Caretakers' report and medication return showed good adherence (98% and 97%) respectively. However, the level of adherence assessed by nevirapine plasma concentration (85%) was significantly lower than caretaker report and medication return (p < 0.001). The agreement between nevirapine plasma concentration and medication return and between nevirapine plasma concentration and caretaker report was weak (k = 0. 131) (k = 0. 09) respectively. Nevirapine plasma concentration below 3 μg/ml was associated with immunosuppression (p = 0. 021) whereas medication return (>5% of prescribed doses) and caretaker reported missing more than one dose within 72 hours prior to interview were not associated with immunosuppression (p = 0. 474), (p = 0. 569) respectively.<br />Conclusion: Lower adherence level observed using nevirapine plasma concentration and its association with immunological response supports the validity of the method and indicates that adherence data obtained from caretaker report and medication return may overestimate the true adherence in paediatric antiretroviral therapy.
- Subjects :
- Adolescent
Adult
Aged
Anti-HIV Agents blood
CD4 Lymphocyte Count
Caregivers
Child
Child, Preschool
Cross-Sectional Studies
Drug Administration Schedule
Drug Combinations
Female
HIV Infections blood
HIV Infections immunology
Humans
Lamivudine therapeutic use
Logistic Models
Male
Middle Aged
Nevirapine blood
Odds Ratio
Stavudine therapeutic use
Surveys and Questionnaires
Tanzania
Young Adult
Zidovudine therapeutic use
Anti-HIV Agents therapeutic use
HIV Infections drug therapy
Medication Adherence statistics & numerical data
Nevirapine therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2431
- Volume :
- 13
- Database :
- MEDLINE
- Journal :
- BMC pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 23768248
- Full Text :
- https://doi.org/10.1186/1471-2431-13-95