Caregivers’ psychosocial assessment for identifying HIV-infected infants at risk of poor treatment adherence: an exploratory study in southern Mozambique

ABSTRACT

Psychosocial support (PSS) to caregivers of HIV-infected infants on antiretroviral treatment (ART) is crucial to ensure ART adherence and sustained long-term viral suppression in children. A specific approach including tools to monitor and understand adherence behavior and risk factors that prevent optimal treatment compliance are urgently needed. This qualitative exploratory study, conducted in southern Mozambique, monitored the infants’ viral response trajectories during 18 months follow-up, as a measure of adherence, reviewed the caregiver’s PSS session notes and the answers to a study questionnaire, to analyze whether the standard PSS checklist applied to infants’ caregivers can identify barriers influencing their adherence. Only 9 of 31 infants had sustained virologic response. Reported factors affecting adherence were: difficulties in drugs administration, shared responsibility to administer treatment; disclosure of child’s HIV status to family members but lack of engagement; mother’s ART interruption and poor viral response. In conclusion, we found that the standard PSS approach alone, applied to caregivers, was lacking focus on many relevant matters that were identified by the study questionnaire. A comprehensive patient-centered PSS package of care, including an adherence risk factor monitoring tool, tailored to caregivers and their children must be developed.

KEYWORDS:

• Antiretroviral therapy
• adherence
• psychosocial support
• HIV-infected infants
• viral suppression
• Mozambique

Acknowledgements

The authors would like to thank all caregivers who participated in the study, the study staff at the Matola Provincial Hospital who took care of infants and caregivers; the Director of Matola Provincial Hospital and Maputo Province Provincial Health Directorate for the support in implementing the study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the National Institute of Health (NIH) under the Grant number AI127347. The funders of this study did not play a role in design of the study, collection, analysis and interpretation of data or in writing the manuscript.