Abstract
As antiretroviral treatments begin to reach HIV-infected children in developing countries, there is an urgent need to develop and document effective and feasible strategies to optimize adherence in children. A comprehensive adherence programme, including ongoing HIV education and care training for children and caregivers, was established in Chiang Rai Hospital, Thailand. One hundred and ten treatment-naïve children, median age 9 years, initiated therapy and participated in this programme between February 2002 and January 2004. Ninety per cent of children during the first 6 months of therapy and 87% during the following 6 months adhered to over 95% of the scheduled drug intakes (pill count). Children over 9 years old and children cared for by grandparents were less likely to be adherent (p = 0.11). In a subset of patients with available viral load measurements, lack of adherence (p = 0.001 and 0.04 at 6 and 12 months, respectively), and irregular attendance to training for children and caregivers were associated with failure to control viral load below 400 copies/ml. No single intervention was associated with strict adherence sustained over time. These results support the need for a comprehensive and long-term approach using multiple tools and educational/support activities to maintain optimal adherence.
Acknowledgments
This study was funded by the AIDS Access Foundation, the Global AIDS Programme, Prevention and Care for Families (CR16), the Programme for HIV Prevention and Treatment (PHPT) – Global Fund to Fight AIDS Tuberculosis and Malaria(antiretroviral drugs, laboratory examinations, viral load measurements, data management, overtime support for a nurse and training). We would like to thank the patients and their caregivers who participated in this programme; Dr Somboonsak Yanpaisan, Director, the paediatricians and the Paediatric Department staffs at Chiang Rai Prachanukroh Regional Hospital; the Chiang Rai PLHA network; Intira Collins and the team from PHPT Thailand.
Notes
∗The list of team members' names is given in the Appendix.