Page 346 - SAHCS HIVMed Journal Vol 20 No 1 2019

Page 3 of 8 Original Research

with standard deviations (s.d.) or medians with interquartile TABLE 1: Sociodemographic and clinical characteristics of the patients and
caregivers in relation to the nevirapine plasma concentrations.
range (IQR) were analysed using independent t-test and Chi- Variable NVP plasma concentrations p
square test (χ ). The outcome variable was NVP plasma NVP ≥ 3 µg/mL NVP < 3 µg/mL
2
concentration (either below or above 3 µg/mL as a measure n % n %
of adherence). Univariable and multivariable logistic Orphan sex
regression and kappa statistic were used to assess agreement Male 81 75.0 27 25.0 0.362
between adherence measures (caregiver report, clinic Female 75 69.4 33 30.6
attendance, CD4 cell count and NVP plasma concentration). Orphan age
The dependent variable was adherence based on NVP plasma 2–4 19 82.6 4 17.4 0.398
concentration. Variables in univariate analysis were included 5–9 62 73.8 22 26.2
in multivariate analysis to assure that all pertinent and 10–14 75 68.8 34 31.2
potentially predictive variables were studied. The association Orphan status
between independent and dependent variables was Single orphan 121 73.8 43 26.2 0.364
32.7
67.3
17
Double orphan
35
measured using odds ratios (OR) with their corresponding HIV disclosure
95% confidence intervals (CI). The significance level for this Yes 97 69.3 43 30.7 0.191
study was set at a p-value of < 0.05. Statistical Package for the No 59 77.6 17 22.4
Social Sciences (SPSS) version 20 was used for the analysis. Caregiver sex
Male 33 78.6 9 21.4 0.306
Ethical consideration Female 123 70.7 51 29.3
Caregiver age
Ethical clearance to conduct the study was obtained from the 15–30 16 80 4 20 0.716
Institutional Review Board (IRB) of the Muhimbili University 31–49 98 71.5 39 28.5
of Health and Allied Sciences (MUHAS). Written informed 50> 42 71.2 17 28.8
consent was obtained from caregivers of the HIV-infected Caregiver marital status
orphan children aged < 8 years old, and child assent together Married/cohabiting 83 74.1 29 25.9 0.508
with caregiver consent was obtained for children aged 8–14 Single 28 65.1 15 34.9
26.2
73.8
16
Divorced/widowed
45
years.
Caregiver education
No formal education 9 60 6 40 0.504
Results Primary education 113 72.4 43 27.6
Sociodemographic characteristics Secondary and post-secondary 34 75.6 11 24.4
Caregiver relation to Orphan
A total of 216 HIV-infected orphans were recruited. They Parent 60 72.3 23 27.7 0.986
were aged between 2 and 14 years (mean ± s.d. age of 9.3 ± Guardian 96 72.2 37 27.8
3.3 years) with over 50% of the participants being between Baseline WHO stage
the ages of 10 and 14 years. All children were on cART for at Stage I & II 53 70.7 22 29.3 0.710
least 6 months, with over 94% of the participants being on Stage III & IV 103 73.0 38 27.0
Current Immunological status
cART for more than a year. A total of 52 children (24.1%) were > 25% or > 500 cells/µL 119 78.3 33 21.7 0.001
double orphans having lost both parents, whereas among the < 25% or < 500 cells/µL 31 54.4 26 45.6
single orphaned children, 37% (n = 80) were paternal orphans cART duration
and 38.9% (n = 84) were maternal orphans. The children were < 1 year 10 83.3 2 16.7 0.377
under the care of either a surviving parent (38.4%) or a > 1 year 146 71.6 58 28.4
relative (61.6%) with more female primary caregivers than Caregiver self-report
male (80.6% female vs. 19.4% male). Caregivers’ ages ranged Good 128 74.4 44 25.6 0.154
between 14 and 70 years (mean age 43.1 [±12.9] years) with a Poor 28 63.6 16 36.4
majority being married or cohabiting (51.9%), which reflects Clinic attendance 135 75.4 44 24.6 0.021
Good
a relatively stable family environment. There were two (2) Poor 21 56.8 16 43.2
caregivers who were below the age of 18, both being siblings NVP, nevirapine; cART, combination antiretroviral therapy.
of the orphans. Detailed sociodemographic characteristics
are presented in Table 1. Using NVP plasma concentrations as the more reliable
adherence outcome measure compared to the other two
cART adherence measures qualitative measures, it was found that children with a higher

Good adherence as assessed by caregiver’s self-report based CD4 cell count (> 500 cells/µL or > 25%) had significantly
on not missing a single cART dose in the past 3 days was higher plasma concentrations (median [IQR] 6.3 [3.7–9.7] µg/
79.6%, whereas adherence based on consistent clinic mL) compared to those with lower CD4 cell counts; median
attendance within 3 days of scheduled appointment visit was (IQR) of 2.8 (0.8 µg/mL – 5.9 µg/mL) ( p ≤ 0.001). Likewise,
82.9%. The analysis of the plasma NVP concentrations patients who had good clinic attendance also had significantly
showed that 72.2% of the children had good adherence based higher median (IQR) plasma NVP concentrations of 5.9
on the NVP concentrations ≥ 3 µg/mL. (3.0 µg/mL – 9.3 µg/mL) compared to those with poor clinic

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