Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at MU-JHU research collaboration clinic-Kampala, Uganda.

Abstract

BACKGROUND: Non adherence reduces the effectiveness of antiretroviral therapy for patients with AIDS. Major challenges remain in paediatric HIV management which includes limited paediatric drug options for resource limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy in the face of non disclosure. AIM To determine levels of adherence to HAART in HIV infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence before and after switching medication formulations of HAART. METHODS: A case series study of 129 Ugandan children with ages between 6 months and 12 years. Good adherence to HAART was defined as taking >_95% of prescribed medications during a specific time period.. It was determined using the three measures pharmacy refill data, quarterly unannounced home visit pill counts, and caregiver self reports. Data was analyzed using STATA version 10.0. In depth interviews were carried out with 10 caregivers and data was analyzed by content analysis. RESULTS: According to caregiver self report 99.2%, 100%, 100% and 99.2% achieved >_95% adherence at 12, 24, 36 and 48 weeks respectively. Using pharmacy refill data, the proportions were 89.9%, 95.4%, 93.8% and for unannounced home visits 89.8%, 92.4% and 88.9% and 86.2%. Median adherence to syrup formulations (97%, IQR 93-98) was significantly lower than tablets (100%, IQR 97-100) {P=0.012, n=28}). Children who switched medication formulations were more likely to have <95% adherence after 48 weeks (p=0.001 RR 1.5, 95% C1 1.2-2.3) compared to those who did not switch. Drug formulation switch did not significantly affect viral load measurements. Caregivers reported that drug administration using co formulation tablets was easier compared to syrus; there were divergent views on whether disclosure was helpful in achieving and maintaining good paediatric adherence. CONCLUSION: In these HIV infected children adherence to tablet formulation was significantly better than syrup formulation. Health workers should strive to use combination tablets for paediatric HIV treatment where possible.