title: Disclosure of HIV status and adherence to daily drug regimens among HIV-infected children in Uganda.
abstract: Pediatric adherence to daily drug regimens has not been widely assessed in Africa where majority of HIV infected children live. Using in-depth interviews of 42 HIV-infected children taking ART and/or cotrimoxazole prophylaxis, and 42 primary caregivers, at a comprehensive HIV/AIDS clinic in Uganda, we evaluated their adherence experiences for purposes of program improvement. Daily drug regimens provided by the pediatric clinic included cotrimoxazole prophylaxis as well as ART and cotrimoxazole combined. Complete disclosure of HIV status by caregivers to children and strong parental relationships were related to good adherence. Structural factors including poverty and stigma were barriers to adherence even for children who had had complete disclosure and a supportive relationship with a parent. To ensure adherence to life-extending medications, our findings underscore the need for providers to support caregivers to disclose, provide on-going support and maintain open communication with HIV-infected children taking cotrimoxazole prophylaxis and ART.
authors.affiliation: CDC-Uganda, Global AIDS Program, Kampala, Uganda. wmb8@ug.cdc.gov
authors.forename: Winnie
authors.initials: W
authors.lastname: Bikaako-Kajura
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Luyirika
authors.forename: David W
authors.initials: DW
authors.lastname: Purcell
authors.forename: Julia
authors.initials: J
authors.lastname: Downing
authors.forename: Frank
authors.initials: F
authors.lastname: Kaharuza
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
authors.forename: Samuel
authors.initials: S
authors.lastname: Malamba
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000517:prevention & control; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006679:HIV Seropositivity; D006801:Humans; D007407:Interviews as Topic; D010349:Patient Compliance; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014342:Truth Disclosure; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents; D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination