Video observations of treatment administration to children on antiretroviral therapy in rural KwaZulu-Natal

ABSTRACT

For children younger than five years, caregivers are responsible for the measurement and administration of antiretroviral medication doses to children. Failure to adhere to the regimen as prescribed may lead to high viral loads (VLs), immune suppression and ultimately drug resistance. In the content of this study, adherence refers to adequate dosing of the medication by a caregiver. Acquired drug resistance to antiretroviral therapy (ART) is prevalent amongst children in South Africa, and poor adherence to the dosing regimen by caregivers may be associated with this problem. In this qualitative study, we purposively recruited 33 caregiver–child dyads from the Hlabisa HIV Treatment and Care Programme database. Children were divided into three groups based on their VL at the time of recruitment. Children with a VL ≥ 400 cps/ml were grouped as unsuppressed (n = 11); children with a VL ≤ 400 cps/ml were grouped as suppressed (n = 12); and children with no VL data were grouped as newly initiated (n = 10). Caregiver–child dyads were visited at their households twice to document, by means of video recording, how treatment was administered to the child. Observational notes and video recordings were entered into ATLAS.ti v 7 and analysed thematically. Results were interpreted through the lens of Ecological Systems Theory and the information–motivation–behavioural skills model was used to understand and reflect on several of the factors influencing adherence within the child’s immediate environment as identified in this study. Thematic video analysis indicated context- and medication-related factors influencing ART adherence. Although the majority of children in this sample took their medicine successfully, caregivers experienced several challenges with the preparation and administration of the medications. In the context of emerging drug resistance, efforts are needed to carefully monitor caregiver knowledge of treatment administration by healthcare workers during monthly clinic visits.

KEYWORDS:

• HIV
• adherence
• barriers
• facilitators
• paediatric
• anti-retroviral treatment

Acknowledgments

We would like to thank all the participants who took part in this research. We also thank Ms Nokuthula Mgenge for her assistance as research assistant. We would also like to thank the Africa Centre’s community advisory board and the Hlabisa hospital management.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding from the Columbia University-Southern African Fogarty AIDS International Training and Research Program (AITRP) funded by the Fogarty International Centre, National Institutes of Health under Grant # D43TW00231 and the US President’s Emergency Plan for AIDS relief (PEPFAR) through HRSA under the terms of T84HA21652 and via the Stellenbosch University Rural Medical Education Partnership Initiative (SURMEPI) and the National Research Foundation (NRF), under Grant 88903 is gratefully acknowledged. Opinions expressed and conclusions arrived at are those of the authors and are not necessarily to be attributed to the NRF. The Africa Centre is funded by the Wellcome Trust, UK, under Grant #097410/Z/