Adherence to antiretroviral drug therapy in children with HIV/AIDS in Jamaica.

OBJECTIVE

We aimed to describe the adherence patterns to antiretroviral therapy (ART) in a cohort of HIV-infected children.

METHODS

Between the periods May to October 2005, 63 HIV-infected children and their caregivers recruited consecutively at four Paediatric Infectious Disease Clinics in Greater Kingston and St. Catherine, Jamaica, were interviewed. Adherence was defined as no missed doses in the last four days. Biomedical markers and factors associated with adherence were explored.

RESULTS

Global adherence level was 85.7% (54/63) and was significantly higher for children in residential care (approaching 100%) compared to 76.3% for children in family care (p = 0.008). Children had median age 7.9 years (range 0.8 - 19.4 years) and 57% were male. Median duration on ART was 18.3 months (range 0.1 - 123.8 months). Median CD4 count and per cent available for 95.2% (60/63) and 92.1% (58/63) children were 440 cells per microL (IQR 268-897 cells/pL) and 24.9% (IQR 15.6 - 42.7%), respectively. Median viral load was 9.60 x 103 copies/ml (IQR 0.05 x 10(3) - 52.50 x 10(3)) with 16% (10/63) having viral loads < or = 50 copies/ml. Children in residential care (n=26), receiving directly observed therapy had higher CD4 counts (p = 0.006) and CD4 per cent (p < or = 0.001). Factors associated with non-adherence were primarily caregiver related, especially long work hours (p = 0.002) and nausea as a side effect of ART (p = 0.007). Non-adherence was positively correlated with missing clinic appointments (r = 0.342, p = 0.009) and increasing age of child (r = 0.310, p = 0.013).

CONCLUSION

In resource-limited settings, psychosocial factors contribute significantly to nonadherence and should complement biomedical markers in predicting adherence to antiretroviral therapy in children.