Challenges of Anti-Retroviral Therapy (ART) among children aged 6 to 15 years in Kabarole District, Uganda

Abstract

Introduction: HIV/AIDS is one of the leading causes of mortality among children in Kabarole district. It is however unknown how many children are on ART and there is very little documented evidence of the challenges faced by children aged 6 to 15 years on ART. Methods: A cross-sectional study was conducted to assess the challenges associated with ART among children aged 6 to 15 years in Kabarole district. Quantitative data were collected using a semi structured interviewer administered questionnaire and qualitative using Key Informant interviews. Adherence levels were assessed using self report information from caretakers and children 10 years and above. Logistic regression models were used to estimate odds ratios (OR’s) of adherence and their associated 95% confidence intervals. Results: As at 30th April 2009, there were 478 children on ARV’s in the district. Of the 332 children in the study, 51% were girls and 66.3% were aged 9-12 years. Using one month recall, 95.5% of the respondent’s adherence was 100%, 1.8% had 95-99% and 2.7% had adherence levels of less than 95%. On 3-day recall, 98.5% had 100% adherence, 1.5% had less than 95% adherence. Major challenges were a low proportion of children on ART, 42.5% of respondents failed to get transport at least once, 51% were orphans, co-trimoxazole stock outs at government facilities, lack of follow up and inadequate support supervision . Conclusions: Co-trimoxazole prophylaxis among children aged 6 to 15 years was found to be a plausible predictor of adherence. Challenges to ART are numerous and solutions to them require a multi-faceted approach. Recommendations: Co-trimoxazole prophylaxis should be prioritised in all ART clinics for children aged 6 to 15 years. There’s need for collaboration between DHT and hospitals in support supervision of lower health units. Home visits and training of staff need to be reinforced.