Patient and caregiver factors affecting adherence to anti-retroviral therapy in children attending Lira Infectious Disease Clinic, Uganda

Abstract

HAART can profoundly inhibit viral replication and delay disease progression, but achieving this potential in clinical practice requires adherence to complex regimens. Sustaining adherence in children represents a significant challenge. There is therefore urgent need to identify constraints to adherence in children and implement interventions to address them. Justification: Knowledge about challenges faced by children in sustaining adherence will help in restructuring the content of current HIV education and counseling programs. Objective: To assess adherence to HAART in HIV positive children attending LIDC. Methodology: This was a cross sectional study that used both the qualitative and quantitative data collection methods. A total of 315 HIV positive children were enrolled consecutively into the study and were interviewed using semi structured questionnaires, in depth and FGD guides between April and May 2009. Data analysis: Quantitative data was managed and analyzed using SPSS. Univariate analysis was used to describe the study population and adherence levels while bivariate logistic regression was used to identify potential predictors of adherence. Qualitative data was analyzed using Nvivo 8, where emerging themes were generated. Results: The overall level of adherence was 71%. Children 12 – 17 years had better adherence (82.8%) than those 11 years and below, while children who knew their sero-status were 2.4 times more likely to be adherent than those who did not. Patient factors notably drug side effects plus stigma and caregiver factors like dual sickness, information gap and communication skills affected adherence. Conclusion: The adherence level for HIV positive children attending LIDC is lower than that desired to achieve good clinical outcomes. Adherence was higher for the older children and positively associated with knowledge of sero status. Lack of information on HIV/AIDS and poor communication skills were major challenges faced by caregivers Recommendation: There is need to intensify education on HIV and communication skills for caregivers, support continuous counseling and carry out more comparative research to determine the best way to achieve optimal adherence to HAART in children.