title: Factors associated with adherence to highly active antiretroviral therapy among children in two referral hospitals, northwest Ethiopia.
abstract: BACKGROUND
  highly active antiretroviral therapy (HAART) results in improved survival, clinical, immunological and virological response for children. Adherence to HAART is one of the very important factors which determine treatment success and occurrence of viral resistance. The need for near perfect adherence to lifelong antiretroviral therapy (ART) during childhood is a major challenge in the administration of HAART to HIV infected children.
  
  
  OBJECTIVE
  the study was aimed to determine the level of adherence and factors associated with adherence to HAART among children in Felege Hiwot and Gondar University referral hospitals.
  
  
  METHODS
  institution based cross-sectional study was conducted on 204 children in the paediatric ART clinics of Gondar University and Felege Hiwot hospitals. Sample size was determined by single population proportion formula and all children on ART for > or = 1 month and coming to the clinic during the data collection period were studied Ethical clearance was obtained from the Institutional Review Board of the University of Gondar. Data were collected by four nurses from the caregivers and patient charts using a pretested and structured questionnaire after informed consent. Descriptive statistics were calculated to describe study population and medical characteristics of participants while binary and multiple logistic regression analyses were used to determine the effect of factors on the outcome variable.
  
  
  RESULTS
  The study included 204 children (123 from Flege Hiwot and 81 from Gondar). One hundred and seven (52.4%) were males and 97(47.6%) were females. Majority (82.4%) of caregivers were females. Thirty days optimum (> or = 95%) adherence rate was 80.9% for children. Adherence counseling before initiation (OR=4.37, 95%CI 1.17 - 16.37), caregiver formal education, (OR=4.85, 95%CI 1.89 - 12.39) and caregiver's ability to identify ARV drug correctly (OR = 8.61, 95%CI 2.59-28.68) were positively associated while care giver substance use (OR=0.31, 95%CI 0.10 - 0.93) was negatively associated with adherence as compared to their counter parts.
  
  
  CONCLUSIONS
  optimum adherence rate to HAART in the study population was lower than the recommended Adherence counseling, caregiver education, substance use by caregiver, identification of ARVs determined adherence to HAART of children. Adherence assessment and counseling efforts should be continually integrated with ART for children and their caregivers.
authors.affiliation: University of Gondar, Gondar Ethiopia.
authors.forename: Daniel
authors.initials: D
authors.lastname: Azmeraw
authors.forename: Belaynew
authors.initials: B
authors.lastname: Wasie
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods* / Q000523:psychology; D017028:Caregivers / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D003376:Counseling; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D012017:Referral and Consultation; D017678:Sex Distribution; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016903:Drug Monitoring