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Caretakers' barriers to pediatric antiretroviral therapy adherence in Vietnam - A qualitative and quantitative study
Insights
Financial burden, lack of knowledge, depression, and stigma are major barriers for caretakers managing pediatric antiretroviral therapy (ART) in Vietnam. Addressing these challenges is crucial for improving ART adherence in children.
Area of Science:
- Public Health
- Pediatrics
- Infectious Diseases
Background:
- Poor adherence to antiretroviral therapy (ART) in children leads to treatment failure and drug resistance, particularly in low and middle-income countries.
- Caretakers play a pivotal role in ensuring ART adherence for pediatric patients, who are often passive recipients of medication.
- Pediatric ART adherence remains a significant challenge in Vietnam, with non-adherence being a primary risk factor for treatment failure.
Purpose of the Study:
- To explore and quantify the barriers faced by caretakers in administering ART to children in Vietnam.
- To identify key factors influencing caretaker burden and their association with pediatric ART adherence.
- To inform the development of targeted interventions to improve pediatric ART adherence.
Main Methods:
- A mixed-methods approach combining qualitative Focus Group Discussions (FGDs) and a quantitative questionnaire-based study.
- FGDs explored societal support, family dynamics, and stigma related to caring for children on ART.
- A 32-item checklist guided the qualitative interviews, followed by a quantitative survey administered to 209 caretakers.
Main Results:
- Common barriers identified include financial burden, lack of ART knowledge-practice (KP), stigma, depression, shifting caretakers, drug palatability, side effects, lack of family support, fixed health check-up schedules, and HIV non-disclosure.
- The most frequently reported barriers were financial burden (69%), KP burden (68%), depression (41%), and stigma (14.8%).
- Rural caretakers and those with less than high school education reported significantly higher financial burdens and stigma.
Conclusions:
- Financial burden, KP burden, depression, and stigma are significant barriers to pediatric ART adherence.
- Factors such as family residence and caretaker education level critically influence these barriers.
- Findings support the development of targeted interventions and a monitoring tool for nurses to address caretaker burdens in pediatric ART clinics.
Background:
Poor antiretroviral therapy (ART) adherence leads to drug resistance and treatment failures. The options for second and third line ART regimens, particularly for pediatric patients, are very limited in low and middle-income countries. HIV-infected children are mostly passive drug-takers, thus caretakers play a very important role in assuring ART adherence. Pediatric ART adherence is still a challenging problem in Vietnam since non-adherence is the major risk factor for treatment failure. Our study explores and measures caretakers' barriers in order to improve pediatric ART adherence in future.
Methods:
Exploring caretakers' barriers was conducted through a qualitative study with Focus Group Discussion (FGD) on two topics: 1. Current society - family support and difficulties in taking care children under ART; 2. Stigma experience. Based on the finding from the qualitative study a quantitative study measuring caretakers' barriers was conducted through a designed questionnaire. Study methods strictly followed the consolidated criteria with 32-item checklist for interviews and focus groups.
Results:
In total eight FGDs with 53 participants were conducted. Common caretakers' barriers to children's ART adherence, were financial burden, lack of ART KP (Knowledge-Practice), stigma, depression, shifting caretaker, drug taste and side effects, lack of family support, fixed health check-up schedule and HIV non-disclosure. In the questionnaire study a total of 209 caretakers participated. The most commonly reported caretakers' barriers were: financial burden (144; 69%), KP burden (143; 68%), depression (85; 41%) and stigma (30; 14.8%). Some caretakers' characteristics that significantly associated with reported barriers (p<0.05). Rural caretakers reported significantly more financial burden (OR=2.26) and stigma (OR=3.53) than urban. Caretakers with under high school level education reported significantly more financial burdens (OR=2.08) and stigma (OR=4.15) compared to caretakers with high school education or over.
Conclusion:
Financial burden, KP burden, depression and stigma were common reported caretakers' barriers to pediatric ART adherence. Family residence, caretaker's education level and job were considered as the key factors determining caretakers' barriers related to financial burden and stigma. These findings may be important for policy makers and researchers in order to develop effective interventions regarding to caretakers' burdens and associated factors. Furthermore, a tool for nurses in monitoring caretakers' barriers to pediatric ART adherence was developed first with FDG, and then interview questionnaire. This tool could be applied and modified easily in any pediatric ART clinic settings in accordance to economic, social and cultural circumstances.
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