Keeping kids in care: virological failure in a paediatric antiretroviral clinic and suggestions for improving treatment outcomes.
The burden of paediatric HIV in South Africa is extremely high. Antiretrovirals (ARVs) are now widely accessible in the country and the clinical emphasis has shifted from initiation of treatment to retention in care. This study describes the cumulative virological failure rate amongst children on ARVs in a peri-urban clinic, and suggests ways in which clinics and partners could improve treatment outcomes. The study was conducted by the non-profit organisation HOPE Cape Town Association. A retrospective file audit determined the cumulative virological failure rate, that is, the sum of all children with a viral load >1000 copies/ml, children on monotherapy, children who had stopped treatment, children lost to follow-up (LTFU) and children who had died. Interviews were conducted with a purposive sample of 12 staff members and a random sample of 21 caregivers and 4 children attending care. Cumulative virological failure rate was 42%, with most of those children having been LTFU. Both staff and caregivers consistently identified pharmacy queues, ongoing stigma and unpalatable ARVs as barriers to adherence. Staff suggestions included use of adherence aids, and better education and support groups for caregivers. Caregivers also requested support groups, as well as "same day" appointments for caregivers and children, but rejected the idea of home visits. Simple, acceptable and cost-effective strategies exist whereby clinics and their partners could significantly reduce the cumulative virological failure rate in paediatric ARV clinics. These include actively tracing defaulters, improving education, providing support groups, and campaigning for palatable ARV formulations.
a HOPE Cape Town Association and Trust , Cape Town , South Africa.
Susan
S
Purchase
a HOPE Cape Town Association and Trust , Cape Town , South Africa.
Jayne
J
Cunningham
b Immunology Unit, Division of Medical Microbiology, Department of Pathology , NHLS and Stellenbosch University , Cape Town , South Africa.
Monika
M
Esser
c Faculty of Medicine and Health Sciences , Stellenbosch University , Cape Town , South Africa.
Donald
D
Skinner
D000293:Adolescent; D019380:Anti-HIV Agents / Q000032:analysis / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017028:Caregivers / Q000193:education / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D009939:Organizations, Nonprofit; D012189:Retrospective Studies; D013019:South Africa; D011795:Surveys and Questionnaires; D016019:Survival Analysis; D016896:Treatment Outcome; D019562:Viral Load / Q000187:drug effects; D016903:Drug Monitoring
D019380:Anti-HIV Agents
HIV; South Africa; children; implementation; retention; strategy