title: Adherence to antiretroviral therapy and its correlates among HIV-infected children at an HIV clinic in New Delhi.
abstract: BACKGROUND
  With the introduction of antiretroviral therapy (ART), the mortality and morbidity of HIV/AIDS have decreased markedly. However, high adherence to ART (>95%) is necessary for a good therapeutic outcome. There is a paucity of data on paediatric  adherence to ART and its correlates from developing countries, particularly India.
  
  
  OBJECTIVE
  To determine the rate of adherence to ART in HIV-infected Indian children and the factors associated with adherence.
  
  
  METHODS
  A cross-sectional study was conducted at an ART clinic in  New Delhi, north India. Caregivers of 90 children were interviewed using a pre-designed, structured questionnaire and checklist. The primary measure of adherence was 4-day caregiver's recall. Adherence rates were correlated with 3-monthly CD4 counts.
  
  
  RESULTS
  Mean (SD, range)  adherence was 91·4% (12·3, 75-100%). Adherence was low (<95%) in 31 (34·4%) patients. On multivariate logistic regression analysis, increasing time since ART initiation (OR 1·08, 95% CI 1·02-1·13), low caregiver educational status  (OR 4·19, 95% CI 1·37-10·88), orphanhood (OR 3·57, 95% CI 1·13-9·25), efavirenz-based ART regimens (OR 3·65, 95% CI 1·05-10·69) and female gender (OR 3·15, 95% CI 1·03-7·68) were  associated with lower adherence. The rise in CD4 count after ART initiation was more marked in the high adherence group, with the difference in the two groups becoming statistically significant after 6 months of ART (median CD4 count 698 vs 355, p=0·016).
  
  
  CONCLUSIONS
  It is possible to achieve high adherence to ART in a resource-limited setting. Caregiver recall is a reliable and inexpensive tool for measuring adherence. Paediatric adherence to ART is influenced by numerous factors and larger studies are needed to address the issue in India.
authors: Department of Paediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India. drmalvikab@gmail.com
authors: M
authors: M
authors: Bhattacharya
authors: A P
authors: AP
authors: Dubey
mesh_terms: D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D017028:Caregivers / Q000191:economics / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016903:Drug Monitoring / Q000379:methods*; D005194:Family Practice / Q000191:economics / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007194:India; D007223:Infant; D008297:Male; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents