Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda

Abstract

Background: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy.

Aim: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations.

Methods: HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University–Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ⩾95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA^® version 10.0.

Results: A total of 129 HIV-infected children were initiated on HAART with 14·7% on syrups and 85·3% on tablet formulations at enrollment. According to caregiver self-reporting, 99·2%, 100%, 100% and 99·2% achieved ⩾95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89·9%, 95·4%, 93·8% and 93·0% and for unannounced home visits were 89·8%, 92·4%, 88·9% and 86·2%, respectively. Median adherence to syrup formulations (97%, IQR 93–98) was significantly lower than for tablets (100%, IQR 97–100, p = 0·012, n = 28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data.

Conclusion: The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.

Keywords:

• Adherence
• formulation
• HAART
• HIV
• paediatric
• Uganda

The authors sincerely thank the mothers and children who volunteered and participated in the ILA study and all the staff of Makerere University–Johns Hopkins University Research Collaboration for their participation in and support of the ILA study. Special thanks to the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) for support through the International Leadership Award (ILA).