Nabukeera-Barungi Nicolette, Kalyesubula Israel, Kekitiinwa Addy, Byakika-Tusiime Jayne, Musoke Philippa
Department of Paediatrics and Child Health, Faculty of Medicine, Makerere University, Kampala, Uganda.
Ann Trop Paediatr. 2007 Jun;27(2):123-31. doi: 10.1179/146532807X192499.
Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala.
To determine the levels of adherence to HAART and identify factors associated with non-adherence.
A cross-sectional study of 170 children aged 2-18 years. Adherence to HAART was defined as taking > or =95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2-3 weeks later.
The 3-day self-reported > or =95% adherence was 89.4% (n=170). Using clinic-based pill counts, 94.1% (n=170) had > or =95% adherence to treatment compared with only 72% (n=164) by unannounced pill counts. When the primary caregiver was the only one who knew the child's serostatus, he/she was three times more likely to be non-adherent (p=0.02, OR 3.34, 95% CI 1.14-9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have > or =95% adherence (p=0.02, OR 0.44, 95% CI 0.20-0.92).
The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child's HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.
在坎帕拉穆拉戈医院儿科艾滋病毒/艾滋病诊所就诊的儿童中，不坚持服药会降低抗逆转录病毒疗法的疗效。
确定高效抗逆转录病毒疗法（HAART）的依从水平，并识别与不依从相关的因素。
对170名2至18岁的儿童进行横断面研究。HAART的依从性定义为服用规定药物的比例≥95%。通过三种方法来确定依从性：照顾者进行的3天自我报告、入组时基于诊所的药丸计数以及2至3周后进行的未通知的家庭药丸计数。
3天自我报告的依从率≥95%为89.4%（n = 170）。基于诊所的药丸计数显示，94.1%（n = 170）的儿童治疗依从率≥95%，而未通知的药丸计数显示依从率仅为72%（n = 164）。当主要照顾者是唯一知晓孩子血清学状态的人时，其不依从的可能性高出三倍（p = 0.02，比值比3.34，95%置信区间1.14 - 9.82）。在开始HAART之前住院两次或更多次的儿童更有可能依从率≥95%（p = 0.02，比值比0.44，95%置信区间0.20 - 0.92）。
通过未通知的药丸计数估计，大多数儿童的依从水平良好。仅向主要照顾者披露儿童的艾滋病毒血清学状态以及仅住院一次或根本未住院与依从性差有关。
