Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children.
Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood.To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 1...
Main Authors: | , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Public Library of Science (PLoS)
2012-01-01
|
Series: | PLoS ONE |
Online Access: | http://europepmc.org/articles/PMC3348916?pdf=render |
id |
doaj-14e02d113f3849c6a2bdd2e82afe304f |
---|---|
record_format |
Article |
spelling |
doaj-14e02d113f3849c6a2bdd2e82afe304f2020-11-24T22:11:40ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0175e3673710.1371/journal.pone.0036737Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children.Jessica E HabererJulius KiwanukaDenis NanseraKathleen RaglandClaude MellinsDavid R BangsbergAdherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood.To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2-10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of ≥ 48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = -0.25, p = 0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6-5.5; p = 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0-2.0; p = 0.04), and caregiver's alcohol use (AOR 3.1, 95%CI 1.8-5.2; p<0.0001). Child's use of co-trimoxazole (AOR 0.5, 95%CI 0.4-0.9; p = 0.009), caregiver's use of ART (AOR 0.6, 95%CI 0.4-0.9; p = 0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4-0.8; p = 0.001), and caregiver feeling ashamed of child's HIV status (AOR 0.5, 95%CI 0.3-0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5-11.5; p = 0.009) and caregiver's alcohol use (AOR 5.5, 95%CI 2.8-10.7; p<0.0001) were associated with ≥ 48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1-0.99; p = 0.049) and increasing assets (AOR 0.7, 95%CI 0.6-0.9; p = 0.0007) were protective against these interruptions.Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development.http://europepmc.org/articles/PMC3348916?pdf=render |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Jessica E Haberer Julius Kiwanuka Denis Nansera Kathleen Ragland Claude Mellins David R Bangsberg |
spellingShingle |
Jessica E Haberer Julius Kiwanuka Denis Nansera Kathleen Ragland Claude Mellins David R Bangsberg Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. PLoS ONE |
author_facet |
Jessica E Haberer Julius Kiwanuka Denis Nansera Kathleen Ragland Claude Mellins David R Bangsberg |
author_sort |
Jessica E Haberer |
title |
Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. |
title_short |
Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. |
title_full |
Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. |
title_fullStr |
Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. |
title_full_unstemmed |
Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. |
title_sort |
multiple measures reveal antiretroviral adherence successes and challenges in hiv-infected ugandan children. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2012-01-01 |
description |
Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood.To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2-10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of ≥ 48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = -0.25, p = 0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6-5.5; p = 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0-2.0; p = 0.04), and caregiver's alcohol use (AOR 3.1, 95%CI 1.8-5.2; p<0.0001). Child's use of co-trimoxazole (AOR 0.5, 95%CI 0.4-0.9; p = 0.009), caregiver's use of ART (AOR 0.6, 95%CI 0.4-0.9; p = 0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4-0.8; p = 0.001), and caregiver feeling ashamed of child's HIV status (AOR 0.5, 95%CI 0.3-0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5-11.5; p = 0.009) and caregiver's alcohol use (AOR 5.5, 95%CI 2.8-10.7; p<0.0001) were associated with ≥ 48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1-0.99; p = 0.049) and increasing assets (AOR 0.7, 95%CI 0.6-0.9; p = 0.0007) were protective against these interruptions.Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development. |
url |
http://europepmc.org/articles/PMC3348916?pdf=render |
work_keys_str_mv |
AT jessicaehaberer multiplemeasuresrevealantiretroviraladherencesuccessesandchallengesinhivinfectedugandanchildren AT juliuskiwanuka multiplemeasuresrevealantiretroviraladherencesuccessesandchallengesinhivinfectedugandanchildren AT denisnansera multiplemeasuresrevealantiretroviraladherencesuccessesandchallengesinhivinfectedugandanchildren AT kathleenragland multiplemeasuresrevealantiretroviraladherencesuccessesandchallengesinhivinfectedugandanchildren AT claudemellins multiplemeasuresrevealantiretroviraladherencesuccessesandchallengesinhivinfectedugandanchildren AT davidrbangsberg multiplemeasuresrevealantiretroviraladherencesuccessesandchallengesinhivinfectedugandanchildren |
_version_ |
1725804721119166464 |