The prevalence and factors associated with non-adherence to combination antiretroviral therapy among children receiving treatment as three TASO Centres.

Abstract

BACKGROUND: In 2005, TASO started implementing a paediatric combination antiretroviral therapy (ART) program at the 11 centres of Entebbe, Gulu, Jinja, Masaka, Masindi, Mbale, Mbarara, Mulago, Rukungiri, Soroti and Tororo. By the end of December 2008, the 11 centres were providing ART to 1,242 eligible children (5.5% of TASO clients on ART). Provision of ART to adult clients had started earlier in 2004 and by the end of December 2008, the 11 centres were providing ART to 21,434 eligible adult clients (94.5% of TASO clients on ART). Funding for both adult and children ART is provided by the presidents emergency plan for AIDS relief (PEPFAR) through centres for disease control and prevention (CDC). The ARV drugs under this program are delivered through responsive, client and community friendly models at client’s homes, community drug distribution points (CDDP) and /or at TASO centres free of charge. The choice of delivery venue is part of the client’s adherence plan agreed upon with the service provider. STUDY OBJECTIVE: To establish the prevalence and factors associated with non-adherence to ART among children receiving treatment at TASO centres in order to identify appropriate strategies that can be adopted to improve adherence at all centres. METHODS: The study was a cross-sectional survey that employed both quantitative and qualitative research methods. A total of 306 children on ART were randomly selected and their caregivers interviewed. Proportions, odd ratios {OR}, 95% confidence intervals {CI} and appropriate p-values were computed.

RESULTS: Prevalence of non-adherence to ART among the group of children under study three days prior to the date of interview was 21.6%. Factors significantly associated with non-adherence were married/cohabiting caregiver {OR=2.84 (95%CI:1.26, 6.43)}, Disclosure of HIV status to the child {OR=2.92 (95%CI:1.44,5.92)}. Children who were on nutritional supplements had reduced odds of non-adherence {OR=0.45 (95%CI: 0.25, 0.81)}. CONCLUSIONS: The study found that children whose caregivers were married/ cohabiting or whose serostatus had been disclosed to them had higher levels of non-adherence to ART. Children who were on nutritional supplements had low levels of non-adherence.