Factors influencing adherence to paediatric antiretroviral therapy in Portharcourt, South- South Nigeria.

introductionThe efficiency of antiretroviral therapy (ART) depends on a near-perfect level of patient's adherence. Adherence in children poses peculiar challenges. The aim of the study was to determine the adherence level and factors influencing adherence among HIV-infected children and adolescents in University of Port Harcourt Teaching Hospital, Nigeria.

methodsA cross-sectional survey of HIV-infected children and adolescents on ART using self-report by the caregiver/child in the past one month.

resultsA total of 213 caregivers and their children were interviewed. A hundred and sixty-two (76.1%) had adherence rates ≥95%. Only 126 (59.2%) were completely (100%) adherent. The commonest caregiver-related factors for missing doses were forgetfulness 48(55.2%), travelled 22(25.3%) and drugs finished 16(18.4%), while the child-related factors were refused drugs 10(11.5%), slept 8(9.2%), and vomited 8(9.2%). Sixty-eight (31.9%) caregivers reported missing clinic visit and reasons given were travelled 18(26.5%), caregiver ill 12(17.6%) and family problems 9(13.2%). Predictors of poor adherence include mother as the primary caregiver (OR 3.32; 95%CI, 1.33-8.67), younger than 5 years (OR 2.62; 95%CI, 1.30-5.31) and presence of a co-morbidity (OR 3.97; 95%CI, 1.92-8.33). Having a medication reminder strategy (OR 6.34; 95%CI, 3.04-13.31), regular clinic visits (OR 8.55; 95%CI 4.01-18.45) and status disclosure (p = 0.008) predicted a better adherence. The caregiver's age (p= 0.11), education (p = 0.86), socioeconomic status (p = 0.89), gender of the child (p = 0.84), type of ART (p = 0.2) and duration of ART (1.0) did not significantly affect adherence.

conclusionAdherence is still suboptimal. Since barriers to Paediatric ART adherence are largely caregiver-dependent, identifying and addressing these barriers in each caregiver-child pair will improve adherence and patient outcome.