title: Effects of leisure activities and psychosocial support on medication adherence and clinic attendance among children on antiretroviral therapy.
abstract: BACKGROUND
  Optimal adherence to antiretroviral therapy (ART) and retention-in-care are essential in HIV management. Through a Kiddies' Club (KC), the study aimed at assessing the impact of social leisures and psychosocial support on ART adherence and clinic attendance in a pediatric ART program.
  
  
  METHODS
  This was a descriptive, longitudinal study, conducted at the Federal Medical Centre, Makurdi, Nigeria, from June 2011 to June 2012. It included 33 ART-experienced children and their caregivers. The study was supplemented with a qualitative focused group discussion, involving 12 discussants. ART adherence, clinic attendance, and clinical and immunoviralogical responses of the children to ART were noted at 6 months and at 12 months of follow-up.
  
  
  RESULTS
  The children comprised 17 males and 16 females, with a median age of 5 years. Financial constraint was the most common reason given for losses to follow-up in quantitative (32/33, 96.9%) and qualitative (12/12, 100.0%) assessments. But, unavailability of means of transportation may still override the benefit that financial assistance can provide, as reported in the qualitative study. The baseline mean hemoglobin level (8.50 g/dL), median CD4 count (187.00 cells/mm(3)); median weight for height z-score (-0.395), and the median body mass index (15.40) increased significantly to respective values of 10.03 g/dL, 1,030.00 cells/mm(3), -0.090, and 18.50, at 6 months (P-values: 0.000), and 10.47 g/dL, 1,203.00 cells/mm(3), 0.420, and 19.20, at 12 months (P-values: 0.000). The baseline median viral load (45,678.00 copies/mL) also decreased significantly, to 200.00 copies/mL at 6 months and at 12 months (P-values: 0.000). There was no attrition from death or loss to follow-up, and adherence to ART was 100%, at 6 months and at 12 months of follow-up.
  
  
  CONCLUSIONS
  Through the KC, children were retained in care, with excellent adherence to ART, and good clinical and immunoviralogical responses to ART, even after being previously lost to follow-up.
authors.affiliation: Department of Paediatrics, Benue State University, Makurdi, Benue State, Nigeria.
authors.forename: Emmanuel Adémólá
authors.initials: EA
authors.lastname: Anígilájé
authors.affiliation: Department of Paediatrics, Benue State University, Makurdi, Benue State, Nigeria.
authors.forename: Othniel Joseph
authors.initials: OJ
authors.lastname: Dabit
authors.affiliation: Department of Paediatrics, Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Ruth Kashimana
authors.initials: RK
authors.lastname: Tyovenda
authors.affiliation: Department of Paediatrics, Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Agnes Jane
authors.initials: AJ
authors.lastname: Emebolu
authors.affiliation: Department of Paediatrics, Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Augustine Aondohemba
authors.initials: AA
authors.lastname: Agbedeh
authors.affiliation: Centre for Clinical Care and Clinical Research, Maitama, Abuja, Nigeria.
authors.forename: Ayodotun
authors.initials: A
authors.lastname: Olutola
authors.affiliation: Department of Family Medicine, Federal Medical Centre, Makurdi, Benue State, Nigeria.
authors.forename: Omolara Olufunmilayo
authors.initials: OO
authors.lastname: Anígilájé
keywords: Makurdi; Nigeria; antiretroviral therapy; children; retention-in-care