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PLoS One. 2018 Feb 21;13(2):e0191848. doi: 10.1371/journal.pone.0191848. eCollection 2018.

Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa.

Author information

1
Indiana University School of Medicine, Indianapolis, IN, United States of America.
2
Regenstrief Institute, Inc, Indianapolis, IN, United States of America.
3
Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
4
School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya.
5
R.M. Fairbanks School of Public Health, Indianapolis, IN, United States of America.
6
University of California San Francisco, San Francisco, CA, United States of America.
7
City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States of America.
8
Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.

Abstract

OBJECTIVE:

To describe antiretroviral therapy (ART) adherence and associated factors for a large HIV-infected pediatric cohort followed by sites of the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) consortium.

METHODS:

This study utilized prospectively collected clinical data from HIV-infected children less than 13 years of age who initiated ART within 4 clinical care programs (with 26 clinical sites) in Kenya, Uganda, and Tanzania and were followed for up to 6 years. Programs used one of 3 adherence measures, including 7-day quantitative recall, 7-day categorical recall, and clinician pill assessments. We fit a hierarchical, three-level, logistic-regression model to examine adherence, with observations nested within patient, and patients within the 26 sites providing pediatric HIV data to this analysis.

RESULTS:

In East Africa, 3,304 children, 52.0% male, were enrolled in care and were subsequently observed for a median of 92 weeks (inter-quartile range [IQR] 50.3-145.0 weeks). Median age at ART initiation was 5.5 years ([IQR] 3.0-8.5 years). "Good" adherence, as reported by each clinic's measures, was extremely high, remaining on average above 90% throughout all years of follow-up. Longer time on ART was associated with higher adherence (adjusted Odds Ratio-aOR-per log-transformed week on ART: 1.095, 95% Confidence Interval-CI-[1.052-1.150].) Patients enrolled in higher-volume programs exhibited higher rates of clinician-assessed adherence (aOR per log-500 patients: 1.174, 95% CI [1.108-1.245]). Significant site-level variability in reported adherence was observed (0.28), with even higher variability among patients (0.71). In a sub-analysis, being an orphan at the start of ART was strongly associated with lower ART adherence rates (aOR: 0.919, 95% CI [0.864-0.976]).

CONCLUSIONS:

Self-reported adherence remained high over a median of 1.8 years in HIV care, but varied according to patient-level and site-level factors. Consistent adherence monitoring with validated measures and attention to vulnerable groups is recommended.

PMID:
29466385
PMCID:
PMC5842873
DOI:
10.1371/journal.pone.0191848
[Indexed for MEDLINE]
Free PMC Article

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