Adherence to antiretrovial therapy and its determinants in HIV positive children attending the AIC Kijabe Hospital, Kenya

Abstract

Background: Adherence to treatment is recognized as the essence of a successful antiretroviral therapy program. Ensuring optimal adherence to antiretroviral drugs requires more than 95% adherence rate. In children adherence is complex since it is pegged on the caretaker. Loss of the first line antiretroviral drugs to resistance due to non-adherence can be catastrophic. Objective: To determine proportion and determinants of adherence among HIV positive children on anti-retroviral therapy at AIC Kijabe hospital. Methods: The cross-sectional study was conducted at AIDS Relief Program Clinic at the AIC Kijabe Hospital. We sampled 214 caretakers of HIV positive children 1-14 years on anti-retroviral therapy for a minimum of three months: recruitment was by random sampling. Interview script were based on a validated modified Pediatric AIDS Clinical Trial Group (PACTG) adherence questionnaire that assesses child and caregivers demographic characteristics, recall of missed doses in past three days, difficulties experienced with administering medication and beliefs about antiretroviral drugs. The chi-square and Fisher’s exact test was used to test for statistical significance between independent and dependent variables. A multiple logistic regression was used to test for associations between adherence and the statistically significant independent variables (caretaker’s age, gender, education and occupation). AP-value of less than 0.05 was considered significant. Results: Out of the 214 children in the study 109 (55.6%) were male, disclosure of their HIV status had been done for 56%. Majority of the caretakers 180(84.1%) were females, 87(40.7%) of the caretakers had attained secondary level of education. Ninety one 91(42.5%) had unskilled occupation. Their mean age (in years) was 41.6 (SD 12.7). More than half of them 128(59.8%) were biological parents of the child. Out of the 214 children 87.4% attained more than 95% optimal adherence rate. Caretakers age (t=2.231, p<0.001), education level (χ2=11.335, p<0.001), occupation (χ2=10.024, p<0.001) were negatively associated with child’s adherence to medication though not statistically significant on the multiple logistic table. Most cited deterrents to adherence were forgetting 87%, interference with caretaker’s schedule 76%, multiple caretakers 54.5% and stigma 47%. Conclusions: Adherence to antiretroviral drugs at AIC Kijabe hospital was high than the low and middle income countries average. Child characteristics’ and care givers characteristics had no association with adherence. Majority of the children had been disclosed to their status. And cited forgetting, scheduling multiple caretakers’ and stigma as deterrents to adherence Recommendation:We recommend clinicians and caretakers’ to encourage disclosure of HIV status to children on antiretroviral drugs in order to optimize adherence to antiretroviral drugs.