title: Barriers to and facilitators of adherence to pediatric antiretroviral therapy in a sub-Saharan setting: insights from a qualitative study.
abstract: Despite the need for HIV-positive children to adhere effectively to antiretroviral treatment (ART), a guiding theory for pediatric ART in resource-limited settings is still missing. Understanding factors that influence pediatric ART adherence is critical to developing adequate strategies. In-depth qualitative interviews were undertaken in Kinshasa, Democratic Republic of the Congo, with 20 sets of HIV disclosed and nondisclosed children along with respective caregivers to better characterize barriers, facilitators, and adherence experiences in children taking ART. Commonly cited barriers included lack of food or nutritional support, lack of assistance or supervision for children, lack of assistance for caregivers, and being unable to remember to take medicines on a consistent basis. Facilitators included having a strong caregiver-child relationship and support system along with strategies for maintaining adherence. Similar themes arose within the child-caregiver sets, but were often characterized differently between the two. Children who were aware of their HIV status displayed fewer instances of frustration and conflict concerning taking medicines and within the child-caregiver relationship. Continued study on pediatric ART adherence should account for differing perspectives of children and caregivers, as well as between status disclosed and nondisclosed children. Areas of future intervention should focus on child-caregiver relationships, disclosure of HIV status, and available nutritional and psychosocial support for children and their caregivers.
authors.affiliation: University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA. bfetzer81@gmail.com
authors.forename: Bradley C
authors.initials: BC
authors.lastname: Fetzer
authors.forename: Bavon
authors.initials: B
authors.lastname: Mupenda
authors.forename: Jean
authors.initials: J
authors.lastname: Lusiama
authors.forename: Faustin
authors.initials: F
authors.lastname: Kitetele
authors.forename: Carol
authors.initials: C
authors.lastname: Golin
authors.forename: Frieda
authors.initials: F
authors.lastname: Behets
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D017028:Caregivers / Q000523:psychology*; D002648:Child; D015023:Democratic Republic of the Congo; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D036301:Qualitative Research; D012944:Social Support; D013240:Stereotyping; D014342:Truth Disclosure; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents