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Page 7 of 8  Original Research


              these findings to the individual. The subjects of this study   References
              were HIV-infected urban children and orphans, that is, not
              representative of the general population of Tanzania. During   1.  UNAIDS. Ending AIDS: Progress towards the 90-90-90 targets [homepage on the
                                                                      Internet].  2017  [cited  2019  May  24].  Available  from:  http://www.unaids.org/
              the study period, routine viral load monitoring was not   sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf.
              available; hence, a more objective long-term view of   2.  UNICEF. Seventh stocktaking report on children & AIDS [homepage on the Internet].
              adherence could not be assessed.                        2016  [cited  2019  May  24].  Available  from:  https://data.unicef.org/wp-content/
                                                                      uploads/2016/12/HIV-and-AIDS-2016-Seventh-Stocktaking-Report.pdf.
                                                                    3.  Mmbando P, Hartwig KA, Hofgren B, et al. Care for the most vulnerable children in
              Conclusion                                              Tanzania: A faith-based model of care and support for children affected by HIV. J Health
                                                                      Care Poor Underserved. 2009;20(4 Suppl):13–21. https://doi.org/10.1353/hpu.0.0195
              This study has demonstrated that significant proportions of   4.  National AIDS Control Program - NACP. National guidelines for the management of
                                                                      HIV and AIDS [homepage on the Internet]. 2012 [cited 2019 May 24]. Available
              HIV-infected orphans on cART have inadequate adherence   from: https://aidsfree.usaid.gov/sites/default/files/hts_policy_tanzania.pdf
              based on plasma NVP concentrations compared to caregiver   5.  Talam NC, Gatongi P, Rotich J, et al., Factors affecting antiretroviral drug adherence
                                                                      among  HIV/AIDS  adult  patients  attending  HIV/AIDS  clinic  at  Moi  Teaching  and
              self-report. The average adherence rates among the orphans   Referral Hospital, Eldoret, Kenya. East Afr J Public Health. 2008;5(2):74–78.
              were found to be low (78.2%) based on the three methods of   6.  MacDonell KK, Jacques-Tiura AJ, Naar S, et al. Predictors of self-reported adherence to
              assessment. Differences among the various methods of    antiretroviral medication in a multisite study of ethnic and racial minority HIV-positive
                                                                      youth. J Pediatr Psychol. 2016;41(4):419–428. https://doi.org/10.1093/jpepsy/jsv097
              estimating adherence indicate a need for multiple     7.  Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):
              measurement methods. There is a wide variation in the   487–497. https://doi.org/10.1056/NEJMra050100
              adherence levels measured by self-reported method,    8.  Marhefka  SL,  Koenig  LJ,  Allison  S,  et  al.  Family  experiences  with  pediatric
                                                                      antiretroviral therapy: Responsibilities, barriers, and strategies for remembering
              consistency  of clinic  attendance and NVP plasma       medications.  AIDS  patient  care  STDS.  2008;22(8):637–647.  https://doi.org/10.
              determination, indicating that efforts are needed to find out   1089/apc.2007.0110
              better methods of adherence measurement for both clinical   9.  Mellins CA, Brackis-Cott E, Dolezal C, et al. The role of psychosocial and family
                                                                      factors  in  adherence  to  antiretroviral  treatment  in  human  immunodeficiency
              care and research. Inadequate caregiver knowledge on    virus-infected children. Pediatr Infect Dis J. 2004;23(11):1035–1041.
              several aspects of HIV/AIDS, unnecessary long waiting time   10. Mellins CA, Dolezal C, Richards A, et al. Abrams, Patterns of HIV status disclosure
                                                                      to perinatally HIV-infected children and subsequent mental health outcomes. Clin
              and forgetfulness were identified as barriers to cART   Child  Psychol  Psychiatry.  2002;7(1):101–114.  https://doi.org/10.1177/13591
              adherence among orphans.                                04502007001008
                                                                    11. Vreeman RC, Wiehe SE, Ayaya SO, et al. Association of antiretroviral and clinic
                                                                      adherence with orphan status among HIV-infected children in Western Kenya. J
              Acknowledgements                                        Acquir  Immune  Defic  Syndr.  2008;49(2):163–170.  https://doi.org/10.1097/
                                                                      QAI.0b013e318183a996
                                                                    12. Kabore L, Muntner P, Chamot E, et al. Self-report measures in the assessment of
              This study would not be successful without active       antiretroviral  medication  adherence:  Comparison  with  medication  possession
              involvement of the caregivers and the children. We also   ratio and HIV viral load. J Int Assoc Provid AIDS Care. 2015;14(2):156–162.
              thank the nurses in those CTCs for instituting the self-report   13.  Vreeman RC, Ayaya SO, Musick BS, et al. Adherence to antiretroviral therapy in a
                                                                      clinical cohort of HIV-infected children in East Africa. PLoS One. 2018; 13(2):e0191848.
              questionnaire to all the caregivers and Ms Dorisia Nanage   14.  De  Requena  DG,  Jimenez-Nacher  I,  Soriano  V.  Changes  in  nevirapine  plasma
              for running the HPLC analysis.                          concentrations over time and its relationship with liver enzyme elevations. AIDS Res
                                                                      Hum Retroviruses. 2005;21(6):555–559. https://doi.org/10.1089/aid.2005. 21.555
                                                                    15. Lamorde M, Fillekes Q, Sigaloff K, et al. Therapeutic drug monitoring of nevirapine
              Competing interests                                     in saliva in Uganda using high performance liquid chromatography and a low cost
                                                                      thin-layer chromatography technique. BMC Infect Dis. 2014;14:473. https://doi.
                                                                      org/10.1186/1471-2334-14-473
              The authors declare that they have no financial or personal   16. Mghamba FW, Minzi OM, Massawe A, et al. Adherence to antiretroviral therapy
              relationships that may have inappropriately influenced them   among HIV infected children measured by caretaker report, medication return,
              in writing this article.                                and drug level in Dar Es Salaam, Tanzania. BMC Pediatr. 2013;13:95.
                                                                    17. Giacomet V, Albano F, Starace F, et al. Adherence to antiretroviral therapy and its
                                                                      determinants  in  children  with  human  immunodeficiency  virus  infection:  A
                                                                      multicentre, national study. Acta Paediatr. 2003;92(12):1398–1402.
              Authors’ contributions                                18. Haberer J, Mellins C. Pediatric adherence to HIV antiretroviral therapy. Curr HIV/
              O.M. conceived the study, supervised data collection and   AIDS Rep. 2009;6(4):194–200.
              provided critical revision of the article; N.M. collected the   19. Fassinou P, Elenga N, Rouet F, et al. Highly active antiretroviral therapies among
                                                                      HIV-1-infected children in Abidjan, Cote d’Ivoire. AIDS. 2004;18(14):1905–1913.
              data and prepared the draft manuscript; S.F.M. was      https://doi.org/10.1097/00002030-200409240-00006
              responsible  for  data  analysis,  data  interpretation  and   20. Brackis-Cott E, Mellins CA, Block M. Current life concerns of early adolescents and
                                                                      their mothers: Influence of maternal HIV. J Early Adoles. 2003;23(1):51–77.
              preparation of the manuscript.                        21. Naar-King S, Montepiedra G, Nichols S, et al. Allocation of family responsibility for
                                                                      illness  management  in  pediatric  HIV.  J  Pediatr  Psychol.  2009.  34(2):187–194.
                                                                      https://doi.org/10.1093/jpepsy/jsn065
              Funding Information                                   22. Bikaako-Kajura  W,  Luyirika  E,  Purcell  DW,  et  al.  Disclosure  of  HIV  status  and
                                                                      adherence to daily drug regimens among HIV-infected children in Uganda. AIDS
              Funding for this study was obtained from the Muhimbili   Behav. 2006;10(4 Suppl):S85–S93.
              University of Health and Allied Sciences (MUHAS).     23. Nabukeera-Barungi  N,  Kalyesubula  I,  Kekitiinwa  A,  et  al.  Adherence  to
                                                                      antiretroviral therapy in children attending Mulago Hospital, Kampala. Ann Trop
                                                                      Paediatr. 2007;27(2):123–131. https://doi.org/10.1179/146532807X192499
              Data availability statement                           24. Chalker J, Andualem T, Minzi O, et al. Monitoring adherence and defaulting for
                                                                      antiretroviral therapy in 5 East African countries: An urgent need for standards. J
                                                                      Int  Assoc  Physicians  AIDS  Care  (Chic).  2008;7(4):193–199.  https://doi.org/10.
              Data sharing is not applicable to this article as no new data   1177/1545109708320687
              were created or analysed in this study.               25. Heidenreich PA. Patient adherence: The next frontier in quality improvement. Am
                                                                      J Med. 2004;117(2):130–132. https://doi.org/10.1016/j.amjmed.2004.03.007
                                                                    26. WHO.  How  to  investigate  adherence  to  antiretroviral  treatment:  An  indicator
              Disclaimer                                              based approach. Geneva: WHO; 2011.
                                                                    27. O’Gorman  MR,  Zijenah  LS.  CD4  T  cell  measurements  in  the  management  of
              The views expressed in the article are those of the authors   antiretroviral  therapy  –  A  review  with  an  emphasis  on  pediatric  HIV-infected
              and not an official position of the institution or funder.  patients. Cytometry B Clin Cytom. 2008;74(Suppl 1):S19–S26. https://doi.org/10.
                                                                      1002/cyto.b.20398
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