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AIDS Care. 2019 Jan;31(1):25-34. doi: 10.1080/09540121.2018.1524113. Epub 2018 Sep 20.

High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana.

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a Departments of Pediatrics, Pharmacology & Public Health , Yale School of Medicine , New Haven , CT , USA.
b Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA.
c Department of Child Health , School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana.
d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana.
e Department of Medicine , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana.
f Rosen Center for Advanced Computing , Purdue University , West Lafayette , IN , USA.
g Johns Hopkins School of Nursing , Baltimore , MD , USA.


Adherence to antiretroviral therapy (ART) remains one of the greatest obstacles in pediatric HIV care. We sought to determine the prevalence of adherence to ART among undisclosed HIV-infected children and adolescents in Ghana. We analyzed baseline data from HIV-infected children and adolescents aged 7-18 years old enrolled in the SANKOFA Pediatric HIV disclosure intervention study in Ghana. Antiretroviral medication adherence was measured using caregiver 3-day recall; child 3-day recall; and pharmacy records for antiretroviral time-to-refill. Four hundred and twenty child-caregiver dyads were enrolled from January 2013 to June 2016. The median adherence (interquartile range), as measured by time-to-refill, was 93.2% (68.0%-100.0%). However, only 47.5% of children had ≥95% adherence ("good adherence") using time-to-refill data. Children of caregivers who had received secondary or higher level of education versus no school (aOR, 2.90, 95% Confidence Interval, CI 1.29-6.56), p = 0.010) or elementary education only (aOR, 2.20, CI, 1.24-3.88, p = 0.007) were more likely to have "good adherence" (≥95%). In this cohort of children unaware of their HIV positive status, median ART adherence rate was sub-optimal (by World Health Organization definition) while 38% had poor adherence (<85%).


Adherence; Sub-Saharan Africa; antiretroviral therapy; pediatrics

[Available on 2020-01-01]

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