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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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