title: Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time.
abstract: We conducted a study to assess the effect of family-based treatment on adherence amongst HIV-infected parents and their HIV-infected children attending the Mother-To-Child-Transmission Plus program in Kampala, Uganda. Adherence was assessed using home-based pill counts and self-report. Mean adherence was over 94%. Depression was associated with incomplete adherence on multivariable analysis. Adherence declined over time. Qualitative interviews revealed lack of transportation money, stigma, clinical response to therapy, drug packaging, and cost of therapy may impact adherence. Our results indicate that providing ART to all eligible HIV-infected members in a household is associated with excellent adherence in both parents and children. Adherence to ART among new parents declines over time, even when patients receive treatment at no cost. Depression should be addressed as a potential barrier to adherence. Further study is necessary to assess the long-term impact of this family treatment model on adherence to ART in resource-limited settings.
authors.affiliation: Department of Epidemiology, School of Public Health, University of California Berkeley, Berkeley, CA 94720-7360, USA. tusiimej@berkeley.edu
authors.forename: Jayne
authors.initials: J
authors.lastname: Byakika-Tusiime
authors.forename: Johanna
authors.initials: J
authors.lastname: Crane
authors.forename: Jessica H
authors.initials: JH
authors.lastname: Oyugi
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ragland
authors.forename: Annet
authors.initials: A
authors.lastname: Kawuma
authors.forename: Philippa
authors.initials: P
authors.lastname: Musoke
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003863:Depression / Q000150:complications*; D004334:Drug Administration Schedule; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007407:Interviews as Topic; D008297:Male; D010349:Patient Compliance; D036301:Qualitative Research; D013997:Time Factors; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents