乌干达一家城市诊所中儿童艾滋病治疗抗逆转录病毒药物片剂和液体制剂的依从性

Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda.

作者信息

Bagenda A, Barlow-Mosha L, Bagenda D, Sakwa R, Fowler M G, Musoke P M

机构信息

Makerere University-Johns Hopkins University Research Collaboration, School of Medicine, College of Health Sciences, Kampala, Uganda.

出版信息

Ann Trop Paediatr. 2011;31(3):235-45. doi: 10.1179/1465328111Y.0000000025.

DOI:10.1179/1465328111Y.0000000025

PMID:21781419

Abstract

BACKGROUND

Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy.

AIM

To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations.

METHODS

HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University-Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ≥95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA(®) version 10.0.

RESULTS

A total of 129 HIV-infected children were initiated on HAART with 14.7% on syrups and 85.3% on tablet formulations at enrollment. According to caregiver self-reporting, 99.2%, 100%, 100% and 99.2% achieved ≥95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89.9%, 95.4%, 93.8% and 93.0% and for unannounced home visits were 89.8%, 92.4%, 88.9% and 86.2%, respectively. Median adherence to syrup formulations (97%, IQR 93-98) was significantly lower than for tablets (100%, IQR 97-100, p = 0.012, n = 28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data.

CONCLUSION

The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.

摘要

背景

扩大儿科艾滋病治疗规模仍面临主要障碍，包括资源有限地区儿科抗逆转录病毒药物选择有限、坚持服用液体制剂存在挑战以及终身治疗导致的治疗疲劳。

目的

确定接受高效抗逆转录病毒治疗（HAART）的HIV感染儿童在随访12周、24周、36周和48周时的依从性水平，并比较从糖浆制剂转换为固定剂量复方（FDC）片剂抗逆转录病毒制剂前后的依从性水平。

方法

在坎帕拉的马凯雷雷大学-约翰·霍普金斯大学护理诊所，对6个月至12岁的HIV感染儿童开始进行抗逆转录病毒治疗。对HAART的良好依从性定义为服用≥95%的规定药物。使用药房配药数据、每季度未事先通知的家访药丸计数和照料者自我报告来测量依从性水平。使用STATA（®）10.0版对数据进行分析。

结果

共有129名HIV感染儿童开始接受HAART治疗，入组时14.7%服用糖浆制剂，85.3%服用片剂制剂。根据照料者自我报告，在12周、24周、36周和48周时，分别有99.2%、100%、100%和99.2%的儿童依从性≥95%。使用药房配药数据，相应比例分别为89.9%、95.4%、93.8%和93.0%；未事先通知的家访结果分别为89.8%、92.4%、88.9%和86.2%。根据药房配药数据，糖浆制剂的中位依从性（97%，四分位间距93 - 98）显著低于片剂制剂（100%，四分位间距97 - 100，p = 0.012，n = 28）。病毒抑制与家访和药房配药依从性数据相关。