title: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Makerere University-Johns Hopkins University Research Collaboration, School of Medicine, College of Health Sciences, Kampala, Uganda. bage311@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Bagenda
authors.forename: L
authors.initials: L
authors.lastname: Barlow-Mosha
authors.forename: D
authors.initials: D
authors.lastname: Bagenda
authors.forename: R
authors.initials: R
authors.lastname: Sakwa
authors.forename: M G
authors.initials: MG
authors.lastname: Fowler
authors.forename: P M
authors.initials: PM
authors.lastname: Musoke
mesh_terms: D000554:Ambulatory Care Facilities; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D014454:Uganda; D014505:Urban Population; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents