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Adherence to combination antiretroviral treatment in children
E Pontali1, M Feasi, F Toscanini
1Department of Infectious Diseases, University of Genoa, Genoa, Italy. pontals@yahoo.com
Insights
Caregivers of children with HIV face challenges with combination antiretroviral therapy adherence. Key issues include medication complexity, swallowing difficulties, and adherence outside the home.
Area of Science:
- Pediatric infectious diseases
- Pharmacological adherence research
- HIV/AIDS treatment outcomes
Background:
- Combination antiretroviral therapy (cART) is crucial for managing HIV in children.
- Nonadherence to cART can lead to treatment failure and disease progression.
- Understanding caregiver challenges is vital for optimizing pediatric HIV care.
Purpose of the Study:
- To evaluate nonadherence rates to cART in children with HIV.
- To identify specific challenges faced by caregivers administering antiretroviral medications to children.
- To inform interventions for improving pediatric HIV treatment compliance.
Main Methods:
- A questionnaire-based study was conducted with caregivers of HIV-infected children undergoing cART.
- Data collected included adherence levels, medication regimens, and caregiver-reported difficulties.
- The study population comprised 44 children with a mean age of 9.4 years.
Main Results:
- A significant proportion of children exhibited nonadherence to cART, with rates of 20.5% (last 3 days) and 31.8% (since last visit).
- Caregivers reported major challenges including the number of pills, difficulty swallowing, school-time medication, child refusal, and food interactions.
- Mothers were the primary caregivers, and only 50% of families had a written treatment schedule.
Conclusions:
- Pediatric nonadherence to HIV therapy is a significant issue, consistent with other studies.
- Interventions should focus on improving drug formulations, enhancing patient/family counseling, and personalizing treatment plans.
- Future research should consider larger, more homogeneous cohorts to improve generalizability.
Purpose:
To assess the level of nonadherence to combination antiretroviral therapy of HIV-infected children and to identify the main problems faced by caregivers when giving medicines to children.
Method:
A questionnaire was administered to the caregivers of HIV-infected children who were under combination antiretroviral treatment and were followed at our institution.
Results:
We evaluated 44 children (mean age, 9.4 years); 13 were treated with a two-drug regimen, 30 with a three-drug regimen, and 1 with a four-drug regimen. Each child received a mean of 8.1 pills and/or syrup doses. In 54.5% of treatments, food restrictions were necessary. The mother was the main person giving medicines to the child (56.8%). A complete written schedule of the child's treatment was present in 50% of families. About 20.5% and 31.8% of children had missed at least one dose of antiretroviral drugs in the last 3 days before assessment and since last visit (1-2 months earlier), respectively. Main problems reported by caregivers were: (a) too many medicines/ pills (34%); (b) difficulty in swallowing pills (29.5%); (c) taking medicines at school or out of home (27.3%); (d) child resisting/refusing therapy/spitting out (25%); and (e) food interactions (22.7%).
Conclusion:
The observed high level of nonadherence was similar to what was reported by other pediatric studies. Specific interventions aimed at improving compliance in pediatric patients were identified: improvement of anti-HIV drug formulations, better counselling for children and their families, and tailoring of antiretroviral treatment. However, caution is necessary in generalizing our results due to the small sample size and to the heterogeneity of the cohort.