Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV Nondisclosure, and Paradoxical Income Effects

Jessica E. Haberer, Adrian Cook, A. Sarah Walker, Marjorie Ngambi, Alex Ferrier, Veronica Mulenga, Cissy Kityo, Margaret Thomason, Desiree Kabamba, Chifumbe Chintu, Diana M. Gibb, David Bangsberg

Research output: Contribution to journalArticle

74 Citations (Scopus)

Abstract

Introduction: A better understanding of pediatric antiretroviral therapy (ART) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence. Methodology/Principal Findings: Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9) initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26) with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS). HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4%) by visual analog scale, 94.8% (IQR 86,100%) by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2%) by clinic pill count, 93.4% (IQR 90.2,96.7%) by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7%) by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013). Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income. Conclusions/Significance: Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.

Original languageEnglish (US)
Article numbere18505
JournalPLoS One
Volume6
Issue number4
DOIs
StatePublished - 2011
Externally publishedYes

Fingerprint

income
HIV
Monitoring
caregivers
RNA
Pediatrics
Caregivers
drug therapy
Africa South of the Sahara
household income
Sub-Saharan Africa
Human immunodeficiency virus 1
therapeutics
HIV-1
monitoring
dosage
Disclosure
Therapeutics
Poverty
poverty

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV Nondisclosure, and Paradoxical Income Effects. / Haberer, Jessica E.; Cook, Adrian; Walker, A. Sarah; Ngambi, Marjorie; Ferrier, Alex; Mulenga, Veronica; Kityo, Cissy; Thomason, Margaret; Kabamba, Desiree; Chintu, Chifumbe; Gibb, Diana M.; Bangsberg, David.

In: PLoS One, Vol. 6, No. 4, e18505, 2011.

Research output: Contribution to journalArticle

Haberer, JE, Cook, A, Walker, AS, Ngambi, M, Ferrier, A, Mulenga, V, Kityo, C, Thomason, M, Kabamba, D, Chintu, C, Gibb, DM & Bangsberg, D 2011, 'Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV Nondisclosure, and Paradoxical Income Effects', PLoS One, vol. 6, no. 4, e18505. https://doi.org/10.1371/journal.pone.0018505
Haberer, Jessica E. ; Cook, Adrian ; Walker, A. Sarah ; Ngambi, Marjorie ; Ferrier, Alex ; Mulenga, Veronica ; Kityo, Cissy ; Thomason, Margaret ; Kabamba, Desiree ; Chintu, Chifumbe ; Gibb, Diana M. ; Bangsberg, David. / Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV Nondisclosure, and Paradoxical Income Effects. In: PLoS One. 2011 ; Vol. 6, No. 4.
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abstract = "Introduction: A better understanding of pediatric antiretroviral therapy (ART) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence. Methodology/Principal Findings: Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9) initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26) with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS). HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4{\%} (IQR 96.1,98.4{\%}) by visual analog scale, 94.8{\%} (IQR 86,100{\%}) by caregiver-reported last missed dose, 96.9{\%} (IQR 94.5,98.2{\%}) by clinic pill count, 93.4{\%} (IQR 90.2,96.7{\%}) by unannounced home-based pill count, and 94.8{\%} (IQR 87.8,97.7{\%}) by MEMS. At 48 weeks, 72.6{\%} of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013). Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income. Conclusions/Significance: Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.",
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AU - Cook, Adrian

AU - Walker, A. Sarah

AU - Ngambi, Marjorie

AU - Ferrier, Alex

AU - Mulenga, Veronica

AU - Kityo, Cissy

AU - Thomason, Margaret

AU - Kabamba, Desiree

AU - Chintu, Chifumbe

AU - Gibb, Diana M.

AU - Bangsberg, David

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AB - Introduction: A better understanding of pediatric antiretroviral therapy (ART) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence. Methodology/Principal Findings: Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9) initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26) with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS). HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4%) by visual analog scale, 94.8% (IQR 86,100%) by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2%) by clinic pill count, 93.4% (IQR 90.2,96.7%) by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7%) by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013). Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income. Conclusions/Significance: Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.

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