Predictors of adherence to antiretroviral treatment and therapeutic success among children in South Africa

Abstract

The recent years have shown an up-scaling of treatment programs for HIV-infected children in resource-limited settings, with an increased focus on adherence. Little is known, however, about the influence of socioeconomic as well as caregivers' health beliefs on both adherence and virologic outcome of pediatric antiretroviral treatment in these settings.

We conducted a cross-sectional study with 57 caregiver–child dyads at a public hospital in Cape Town, South Africa. Adherence was electronically monitored over three months, viral loads were available pre- and post-study. Caregivers answered questionnaires on their socioeconomic situation, attitudes toward and knowledge about treatment, and quality of life.

Young children with a mean age of 51 months (SD 25.6) were investigated, and all were cared for by female caregivers. Mean adherence was 81%, and 67% of children achieved virologic suppression (VS). Household income, educational status, and child characteristics were not significantly correlated with adherence. Disclosure of both the child's and the caregiver's HIV status was linked to achieving VS and was a significant predictor for VS. A model including child's health status, caregiver's language skills, caregiver's disclosure, and perceived stigmatization could explain 95% of the variance in VS.

Adherence and VS were not associated with socioeconomic factors in this population. Social factors such as stigmatization, fear of disclosure, and caregivers' attitudes toward the health-care system influenced VS but not adherence.

Keywords:

• HIV
• pediatric
• adherence
• social determinants of health
• resource-limited setting

Acknowledgements

The authors would like to thank Dr. Paul Roux for his invaluable support during the conception and conducting of the study at Groote Schuur Hospital and to Anna Hanxi He for her support during critical periods. Our highest appreciation goes toward all children and caregivers who participated in the study.