Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda

Abstract Background: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy. Aim: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations. Methods: HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University–Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ⩾95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA® version 10.0. Results: A total of 129 HIV-infected children were initiated on HAART with 14·7% on syrups and 85·3% on tablet formulations at enrollment. According to caregiver self-reporting, 99·2%, 100%, 100% and 99·2% achieved ⩾95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89·9%, 95·4%, 93·8% and 93·0% and for unannounced home visits were 89·8%, 92·4%, 88·9% and 86·2%, respectively. Median adherence to syrup formulations (97%, IQR 93–98) was significantly lower than for tablets (100%, IQR 97–100, p = 0·012, n = 28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data. Conclusion: The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.

[1]  L. Myer,et al.  Standard Measures are Inadequate to Monitor Pediatric Adherence in a Resource-Limited Setting , 2010, AIDS and Behavior.

[2]  M. Fowler,et al.  Growth, immune and viral responses in HIV infected African children receiving highly active antiretroviral therapy: a prospective cohort study , 2010, BMC pediatrics.

[3]  M. Fowler,et al.  Response to Antiretroviral Therapy in HIV-Infected Ugandan Children Exposed and Not Exposed to Single-Dose Nevirapine at Birth , 2009, Journal of acquired immune deficiency syndromes.

[4]  J. Haberer,et al.  Pediatric adherence to HIV antiretroviral therapy , 2009, Current HIV/AIDS reports.

[5]  M. Egger,et al.  Paediatric antiretroviral treatment programmes in sub-Saharan Africa: a review of published clinical studies , 2009, African journal of AIDS research : AJAR.

[6]  J. Overbaugh,et al.  Medication diaries do not improve outcomes with highly active antiretroviral therapy in Kenyan children: a randomized clinical trial , 2009, Journal of the International AIDS Society.

[7]  B. Eley,et al.  Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study , 2008, BMC pediatrics.

[8]  W. Nyandiko,et al.  A Systematic Review of Pediatric Adherence to Antiretroviral Therapy in Low- and Middle-Income Countries , 2008, The Pediatric infectious disease journal.

[9]  L. Myer,et al.  Electronic Measurement of Adherence to Pediatric Antiretroviral Therapy in South Africa , 2008, The Pediatric infectious disease journal.

[10]  P. Musoke,et al.  Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala , 2007, Annals of tropical paediatrics.

[11]  R. Bunnell,et al.  Disclosure of HIV Status and Adherence to Daily Drug Regimens Among HIV-infected Children in Uganda , 2006, AIDS and Behavior.

[12]  D. Bangsberg,et al.  The Price of Adherence: Qualitative Findings From HIV Positive Individuals Purchasing Fixed-Dose Combination Generic HIV Antiretroviral Therapy in Kampala, Uganda , 2006, AIDS and Behavior.

[13]  A. Castro,et al.  Adherence to Antiretroviral Therapy: Merging the Clinical and Social Course of AIDS , 2005, PLoS medicine.

[14]  T. Puthanakit,et al.  Efficacy of highly active antiretroviral therapy in HIV-infected children participating in Thailand's National Access to Antiretroviral Program. , 2005, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  D. Bangsberg,et al.  Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting , 2004, Journal of acquired immune deficiency syndromes.

[16]  R. Detels,et al.  Changes in adherence to highly active antiretroviral therapy medications in the Multicenter AIDS Cohort Study* , 2004, AIDS.

[17]  D. Bangsberg,et al.  Measuring Adherence to Antiretroviral Therapy in a Diverse Population Using a Visual Analogue Scale , 2004, HIV clinical trials.

[18]  J. Farley,et al.  Assessment of adherence to antiviral therapy in HIV-infected children using the Medication Event Monitoring System, pharmacy refill, provider assessment, caregiver self-report, and appointment keeping. , 2003, Journal of acquired immune deficiency syndromes.

[19]  D. Gibb,et al.  Adherence to prescribed antiretroviral therapy in human immunodeficiency virus-infected children in the PENTA 5 trial , 2003, The Pediatric infectious disease journal.

[20]  A. Molassiotis,et al.  Factors associated with adherence to antiretroviral medication in HIV-infected patients , 2002, International journal of STD & AIDS.

[21]  E. Morse,et al.  Reported adherence as a determinant of response to highly active antiretroviral therapy in children who have human immunodeficiency virus infection. , 2002, Pediatrics.

[22]  J. Tolson,et al.  Correlation between self-reported adherence to highly active antiretroviral therapy (HAART) and virologic outcome , 2001, Advances in therapy.

[23]  R. Hays,et al.  A Comparison Study of Multiple Measures of Adherence to HIV Protease Inhibitors , 2001, Annals of Internal Medicine.

[24]  D. Nau,et al.  The relationship of disease severity, health beliefs and medication adherence among HIV patients , 2000, AIDS care.

[25]  A. Wu,et al.  Patient-reported nonadherence to HAART is related to protease inhibitor levels. , 2000 .

[26]  M. Gill,et al.  Long-Term Patient Adherence to Antiretroviral Therapy , 2000, The Annals of pharmacotherapy.

[27]  V L Yu,et al.  Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: prospective assessment with implications for enhancing compliance. , 1996, AIDS care.