title: Caregiver-reported antiretroviral therapy non-adherence during the first week and after a month of treatment initiation among children diagnosed with HIV in Ethiopia.
abstract: To achieve optimal virologic suppression for children undergoing antiretroviral therapy (ART), adherence must be excellent. This is defined as taking more than 95% of their prescribed doses. To our knowledge, no study in Ethiopia has evaluated the level of treatment adherence at the beginning of the child's treatment. Our aim was therefore to evaluate caregiver-reported ART non-adherence among children and any predictors for this during the early course of treatment. We conducted a prospective cohort study of 306 children with HIV in eight health facilities in Ethiopia who were registered at ART clinics between 20 December 2014 and 20 April 2015. The adherence rate reported by caregivers during the first week and after a month of treatment initiation was 92.8% and 93.8%, respectively. Our findings highlight important predictors of non-adherence. Children whose caregivers were not undergoing HIV treatment and care themselves were less likely to be non-adherent during the first week of treatment (aOR = 0.17, 95% CI: 0.04, 0.71) and the children whose caregivers did not use a medication reminder after one month of treatment initiation (aOR = 5.21, 95% CI: 2.23, 12.16) were more likely to miss the prescribed dose. Moreover, after one month of the treatment initiation, those receiving protease inhibitor (LPV/r) or ABC-based treatment regimens were more likely to be non-adherent (aOR = 12.32, 95% CI: 3.25, 46.67). To promote treatment adherence during ART initiation in children, particular emphasis needs to be placed on a baseline treatment regimen and ways to issue reminders about the child's medication to both the health care system and caregivers. Further, large scale studies using a combination of adherence measuring methods upon treatment initiation are needed to better define the magnitude and predictors of ART non-adherence in resource-limited settings.
authors.affiliation: a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden.
authors.forename: Mulatu
authors.initials: M
authors.lastname: Biru
authors.affiliation: c Management Sciences for Health , Addis Ababa , Ethiopia.
authors.forename: Degu
authors.initials: D
authors.lastname: Jerene
authors.affiliation: a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden.
authors.forename: Pia
authors.initials: P
authors.lastname: Lundqvist
authors.affiliation: b School of Public Health, Addis Ababa University , Addis Ababa , Ethiopia.
authors.forename: Mitikie
authors.initials: M
authors.lastname: Molla
authors.affiliation: d Department of Paediatrics and Child Health , School of Medicine, Addis Ababa University , Addis Ababa , Ethiopia.
authors.forename: Workeabeba
authors.initials: W
authors.lastname: Abebe
authors.affiliation: a Department of Health Sciences, Faculty of Medicine , Lund University , Lund , Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Hallström
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055118:Medication Adherence; D011446:Prospective Studies; D057566:Self Report; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: ART non-adherence; Ethiopia; HIV; caregivers; children; predictors