High prevalence of non-adherence to antiretroviral therapy among undisclosed HIV-infected children in Ghana

ABSTRACT

Adherence to antiretroviral therapy (ART) remains one of the greatest obstacles in pediatric HIV care. We sought to determine the prevalence of adherence to ART among undisclosed HIV-infected children and adolescents in Ghana. We analyzed baseline data from HIV-infected children and adolescents aged 7–18 years old enrolled in the SANKOFA Pediatric HIV disclosure intervention study in Ghana. Antiretroviral medication adherence was measured using caregiver 3-day recall; child 3-day recall; and pharmacy records for antiretroviral time-to-refill. Four hundred and twenty child-caregiver dyads were enrolled from January 2013 to June 2016. The median adherence (interquartile range), as measured by time-to-refill, was 93.2% (68.0%–100.0%). However, only 47.5% of children had ≥95% adherence (“good adherence”) using time-to-refill data. Children of caregivers who had received secondary or higher level of education versus no school (aOR, 2.90, 95% Confidence Interval, CI 1.29–6.56), p = 0.010) or elementary education only (aOR, 2.20, CI, 1.24–3.88, p = 0.007) were more likely to have “good adherence” (≥95%). In this cohort of children unaware of their HIV positive status, median ART adherence rate was sub-optimal (by World Health Organization definition) while 38% had poor adherence (<85%).

KEYWORDS:

• Adherence
• Sub-Saharan Africa
• antiretroviral therapy
• pediatrics

Acknowledgments

We thank the Sankofa Project caregiver and child dyads for their participations. We are grateful to the staff at Pediatric AIDS Clinics at Korle-Bu and Komfo Anokye Teaching Hospitals and the Ghana–Yale Partnership for Global Health for their support.

The content of the paper is solely the responsibility of the authors and does not necessarily represent the official view of NIH.

Disclosure statement

No potential conflict of interest was reported by the authors.

Clinicaltrials.gov Identifier

NCT01701635

Additional information

Funding

This study was made possible by a grant from NIH/NICHD [grant number R01HD074253]. JN was supported by the Doris Duke Charitable Foundation, through a grant supporting the Doris Duke International Research Fellows Program at Yale University School of Medicine.