title: Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya.
abstract: BACKGROUND
  To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya.
  
  
  METHODS
  We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/AIDS.
  
  
  RESULTS
  This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective; for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95%CI 93.16-96.74) at 12 months after the time of initiation of HAART.
  
  
  CONCLUSIONS
  Our model of pediatric HIV/AIDS care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings.
authors.affiliation: Operational Cell Belgium, Médecins Sans Frontières, Nairobi, Kenya. vwjoelle@gmail.com
authors.forename: Joelle
authors.initials: J
authors.lastname: Van Winghem
authors.forename: Barbara
authors.initials: B
authors.lastname: Telfer
authors.forename: Tony
authors.initials: T
authors.lastname: Reid
authors.forename: Judith
authors.initials: J
authors.lastname: Ouko
authors.forename: Angela
authors.initials: A
authors.lastname: Mutunga
authors.forename: Zaina
authors.initials: Z
authors.lastname: Jama
authors.forename: Shobha
authors.initials: S
authors.lastname: Vakil
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D015331:Cohort Studies; D006678:HIV / Q000187:drug effects*; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007630:Kenya / Q000453:epidemiology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods; D015995:Prevalence; D015397:Program Evaluation; D012944:Social Support; D016896:Treatment Outcome