Page 344 - SAHCS HIVMed Journal Vol 20 No 1 2019

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 8 Original Research

Adherence to combination antiretroviral therapy

among orphaned children in Dar es Salaam, Tanzania

Authors: Background: Adherence to combination antiretroviral therapy (cART) among HIV-infected
Sabina F. Mugusi 1 children is often complicated by various factors including medication formulation, dosing
Nassoro Mopei 2
Omary Minzi frequency, drug toxicities, age and developmental stage, psychosocial and behavioural
1
characteristics of both children and caregivers and can additionally be complicated by being
Affiliations: an orphan.
1 Department of Clinical
Pharmacology, School of Objectives: This study was aimed at determining the factors and the extent of their influence
Medicine, Muhimbili on cART adherence among HIV-infected orphaned children attending Care and Treatment
University of Health and
Allied Sciences, Dar es Centres (CTCs) in Dar es Salaam, Tanzania.
Salaam, United Republic of Methods: A cross-sectional study was performed, which assessed adherence in HIV-positive
Tanzania
orphaned children aged 2–14 years receiving nevirapine (NVP) based cART for at least
2 Local Government Authority, 6 months. Data was collected using questionnaires administered to primary caregivers of HIV-
Dar es Salaam, United infected orphaned children, the review of medical files, and the laboratory measurement of
Republic of Tanzania NVP plasma concentrations and CD4 counts. Adherence to cART was determined based on
caregivers’ self-report, consistency of clinic attendance and NVP plasma concentrations.
Corresponding author:
Sabina Mugusi, Results: Among the 216 enrolled orphaned children, adherence to cART was found to be
[email protected]
79.6%, 82.9% and 72.2% respectively based on caregivers’ self-report, clinic attendance and
Dates: NVP plasma levels. Significant reductions in NVP concentrations (< 3 µg/mL) were seen
Received: 07 Feb. 2019 among children with poor immunological outcomes, poor clinic attendance (p < 0.05) and
Accepted: 05 May 2019 were suggested by caregivers’ self-reported adherence (p = 0.06). Adherence challenges
Published: 06 Aug. 2019
identified by caregivers included financial constraints (87.5%), lengthy waiting times at clinics
How to cite this article: (75.5% spent > 2 h at the clinic) and low HIV knowledge among caregivers.
Mugusi SF, Mopei N, Minzi O.
Adherence to combination Conclusion: Significant numbers of HIV-infected orphans have poor adherence to cART
antiretroviral therapy among ranging between 17% and 28% based on different assessment methods. Inadequate caregiver
orphaned children in Dar es knowledge of HIV/AIDS, long clinic waiting times and forgetfulness were identified as
Salaam, Tanzania. S Afr J HIV
Med. 2019;20(1), a954. barriers to cART adherence in these orphans.
https://doi.org/10.4102/ Keywords: cART; Adherence; Nevirapine; Tanzania; Orphans.
sajhivmed.v20i1.954

Copyright:
© 2019. The Authors. Introduction
Licensee: AOSIS. This work
is licensed under the Three decades on, human immunodeficiency virus (HIV) infection continues to be a global public
Creative Commons health problem. The widespread use of combination antiretroviral therapy (cART) has reduced
Attribution License. new HIV infections globally, including a 56% drop among children between 2010 and 2016.
1
Approximately 17 million children have lost one (single orphan) or both parents (double orphan)
to this pandemic globally with a staggering 90% of these children living in sub-Saharan Africa. In
2
Tanzania, there are about 1 million children without parents because of HIV and AIDS; of this,
about 40 000 are infected with HIV. 3,4
Poor adherence to cART among HIV-infected children and adolescents is common and has
various contributory causes. Drug-related factors such as formulation of drugs, dosing frequency,
5
toxicities and side effects can affect adherence. The child’s age and developmental stage, along
with psychosocial and behavioural characteristics of children and caregivers, have also been
associated with poor adherence to cART. 6,7,8 In most resource-limited settings, the death of one or
two parents has a great effect in terms of financial, material and emotional support in caregiving
situations. In addition to emotional stress, orphans face numerous stressors that could impede
9
Read online: their cooperation with treatment and that present significant barriers to maintaining 100%
Read online:
Scan this QR adherence to cART. 10,11
Scan this QR
code with your
code with your
smart phone or
smart phone or
mobile device Adherence to cART suppresses viral replication, delays disease progression and avoids the
mobile device
to read online.
to read online.
emergence of viral resistance. Apart from the regular measurement of the viral load, there is no
7
http://www.sajhivmed.org.za 337 Open Access