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Assessing reported adherence to antiretroviral therapy using the method of verbal recall in children from Kwa-Zulu Natal, South Africa.

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Sub-Saharan Africa has the highest number of children living with HIV. HIV is one of the major causes of under-five mortality in Africa. Antiretroviral therapy in the paediatric population has improved mortality, led to a better quality of life, as well as overall health and well-being of children. Adherence is a critical factor in determining treatment outcomes and success. Non-adherence to therapy increases risk of treatment failure, delays immunological recovery and increases opportunistic infections. In the paediatric population, there is a paucity of studies assessing adherence rates, particularly in resource limited settings. Adherence behaviour is found to be more complex in children. A number of factors affect adherence in children. These include socio-economic factors, medication factors as well as healthcare provider dynamics. The purpose of this secondary analysis of a prospective study was to describe adherence in a cohort of children attending a regional hospital in Kwa-Zulu Natal, South Africa, from September 2006 until October 2009. This study also examined factors associated with adherence such as age of the child, gender, as well as the role of the primary caregiver. Since there is no “gold standard” for assessing adherence to antiretroviral therapy, this area of research needs to be explored further. Secondly, assessing factors associated with adherence will assist in looking at ways to improve treatment outcome. In the main study, prospective patients who were treatment naïve and met criteria to commence antiretroviral therapy were identified in outpatients and clinics. Baseline and follow-up questionnaires were used to capture information including adherence details over the preceding week as well as since the last visit to hospital. Adherence was assessed using the method of verbal recall. Missed doses and the reasons for these were recorded and analysed. Additional factors possibly associated with adherence were also recorded and analysed further. This study reported an overall adherence rate of 94 per cent, similar to rates reported in other studies. Adherence rates over the past week as well as since the patient’s last visit were similar. There was a substantial degree of agreement between verbal recall for the preceding week as well as since the last visit (kappa statistic 0.64, p < 0.005). It was found that children older than five years were more likely to be adherent than those under five years (OR 0.871, 95 % CI 0.22-3.376) and males were twice as likely to adhere as females (OR=2.05, 95% CI 0.49 -8.59). The impact of this study is that it will provide information on adherence in children in Kwa-Zulu Natal, South Africa. This could encourage other such studies to be undertaken to improve adherence rates and hence treatment success. By examining factors associated with adherence as well as identifying possible barriers, we may improve treatment success in children. Adherence to antiretroviral therapy is important, especially in the paediatric population as it is shown to increase survival, improve immunity, as well as help prevent the development of opportunistic infections. Sub-optimal adherence is associated with treatment failure and drug resistance. The use of verbal recall as a measure of adherence is useful in a resource limited setting.


Master of Medical Science in Paediatrics and Child Health. University of KwaZulu-Natal. Durban, 2017.