Chimhuya S, Nathoo K J, Rusakaniko S
Cent Afr J Med. 2013 Sep-Dec;59(9-12):63-70.
Non-adherence reduces the effectiveness of antiretroviral therapy. Knowledge of factors associated with non-adherence would assist clinicians and program planners to design and implement interventions to improve adherence and therefore treatment outcomes.
To determine the prevalence and factors associated with non-adherence to Highly Active Antiretroviral Therapy (HAART) in children less than 10 years of age.
A cross-sectional study of 216 caregivers and children less than 10 years of age who had received HAART for at least 60 days prior to this study. Non-adherence was defined as taking less than 95% of prescribed doses. Caregiver self-reports of missed doses in the 30 days preceding a clinic visit, and clinic based pill counts were used to determine non-adherence.
Of the 228 children selected, 216 (94.7%) study participants were assessed using the self-report method. Pill count assessment was done on only 96 (44%) participants who produced unused pills on their review dates. Caregiver self-reports (n=216) estimated the prevalence of non-adherence to be 7.4% (95%: CI 3.90 10.90) whereas clinic-based pill counts (n=96) yielded a higher estimate of 18.8% (95% CI 10.94 26.56). In a regression analysis based on pill count, two or fewer siblings (OR=6.26, 95% CI 1.64-23.95) or adults (OR=3.73, 95% CI: 1.01-13.78) in the household were independently associated with non-adherence to HAART. Of the 16 participants who were non adherent by pill count the reasons for missing doses were, attending gatherings (funeral, church), caregiver forgetting to give dose, medication running out, not understanding dosing instructions, concurrently taking other medicines such as anti tuberculosis drugs and cotrimoxazole, child visiting relatives during school vacation, and inconsistent supply of drugs in the hospital.
The prevalence of non adherence using pill count method was high at this clinic. Caregiver reports of missed doses underestimated the prevalence of non-adherence to HAART. Having fewer siblings or adults in the household to assist with dosing are strongly associated with non-adherence to HAART in this population of children.
治疗依从性差会降低抗逆转录病毒疗法的疗效。了解与治疗依从性差相关的因素将有助于临床医生和项目规划者设计并实施干预措施，以提高依从性，进而改善治疗效果。
确定10岁以下儿童高效抗逆转录病毒疗法（HAART）治疗依从性差的患病率及其相关因素。
对216名照顾者及其10岁以下儿童进行横断面研究，这些儿童在本研究前已接受HAART治疗至少60天。治疗依从性差定义为服药量少于规定剂量的95%。通过照顾者自我报告在门诊就诊前30天内漏服的剂量，并结合门诊的药丸计数来确定治疗依从性差的情况。
在入选的228名儿童中，216名（94.7%）研究参与者采用自我报告法进行评估。仅对96名（44%）在复查日期提供未使用药丸的参与者进行了药丸计数评估。照顾者自我报告（n = 216）估计治疗依从性差的患病率为7.4%（95%：CI 3.90 - 10.90），而基于门诊的药丸计数（n = 96）得出的患病率更高，为18.8%（95% CI 10.94 - 26.56）。在基于药丸计数的回归分析中，家庭中有两个或更少的兄弟姐妹（OR = 6.26，95% CI 1.64 - 23.95）或成年人（OR = 3.73，95% CI：1.01 - 13.78）与HAART治疗依从性差独立相关。在通过药丸计数显示治疗依从性差的16名参与者中，漏服剂量的原因包括参加聚会（葬礼、教堂活动）、照顾者忘记给药、药物用完、不理解给药说明、同时服用其他药物（如抗结核药物和复方新诺明）、孩子在学校假期走亲访友以及医院药品供应不稳定。
该门诊采用药丸计数法得出的治疗依从性差的患病率较高。照顾者报告的漏服剂量低估了HAART治疗依从性差的患病率。在这个儿童群体中，家庭中协助给药的兄弟姐妹或成年人较少与HAART治疗依从性差密切相关。
