A comprehensive programme to strengthen adherence to antiretroviral drug therapy and achieve virological control in HIV infected children in Thailand

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.

Keywords:

• Adherence
• anti-retroviral drugs
• children
• Thailand
• cohort
• viral load
• fixed dose combination
• nevirapine
• developing country
• Globle Fund
• tuberculosis
• malaria
• daycare

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.