Assessment of adherence to antiretroviral treatment in orphaned children in Dar es salaam Tanzania

Abstract

The study was conducted at pediatric HIV clinics of Dar es Salaam Municipal Hospitals between June, 2013 and September, 2013 to determine ART adherence levels and factors influencing adherence to ART among HIV-infected orphan children. A total of 216 HIV-infected orphan children aged between 2 and 14 years receiving ART and their caretakers were recruited. Data were collected using questionnaire and review of patient record forms (CTC2). On the other hand blood samples were collected for determination of nevirapine plasma levels by High Performance Liquid Chromatography (HPLC). Data analysis was performed using SPSS version 20 software. The ART adherent proportions established were 79.6% by caretaker self report, 82.9% by clinic attendance consistency and 72.2% by nevirapine plasma levels determination. It was observed that 72% of HIV-infected patients on ART had increased CD4 counts whereas 28% of patients had blunted CD4 count responses. It was revealed that 25.5% of interviewed research subjects are not familiar with major means of HIV transmission. Forgetfulness was cited by 90.7% of respondents to be one of challenges facing caretakers in taking orphan child for drug refill. An estimated 75.5% of study population reported to spend more than two hours from arriving at clinic to getting ARVs. It was concluded that significant proportions of HIV-infected orphans on ART attending CTCs in Dar es Salaam have inadequate adherence and inappropriate CD4 response. Inadequate HIV/AID knowledge, unnecessary long waiting time and forgetfulness were identified to impair ART adherence of orphans. The study recommended more attention should be paid on ART adherence in HIV-infected orphan children including initiation of interventions to promote adherence in this pediatric category.