Abstract:
Background: Pediatric adherence to antiretroviral therapy (ART) is
not well studied in resource-limited settings. Reported ART
adherence may be influenced by contextual factors, such as orphan
status.
Objectives: The objectives of this study were to describe self- and
proxy-reported pediatric ART adherence in a resource-limited
population and to investigate associated contextual factors.
Patients and Methods: This was a retrospective study involving
pediatric, HIV-infected patients in Western Kenya. We included
patients aged 0–14 years, who were on ART and had at least
1 adherence measurement ( N = 1516). We performed logistic
regression to assess the association between orphan status and odds
of imperfect adherence, adjusting for sex, age, clinic site, number of
adherence measures, and ART duration, stratified by age and ART
duration.
Results: Of the 1516 children, only 33% had both parents living
when they started ART. Twenty-one percent had only father dead,
28% had only mother dead, and 18% had both parents dead. Twenty nine percent reported imperfect ART adherence. The odds of ART
non adherence increase for children with both parents dead. Fifty seven percent of children had imperfect clinic adherence. There was
no significant association between orphan status and imperfect clinic
adherence.
Conclusions: The majority of pediatric patients in this resource limited setting maintained perfect ART adherence, though only half kept all scheduled clinic appointments. Understanding contextual
factors, such as orphan status, will strengthen adherence interventions.
