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Published on: January 31, 2020
A treatment-support intervention evaluated in South African paediatric populations with HIV infection or tuberculous
Sabine L van Elsland1,2, Remco P H Peters3, Maarten O Kok4
1Department of Pediatric Infectious Diseases and Immunology, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.
Insights
A new intervention improved quality of life for children with HIV and their families. While treatment adherence was unaffected, the program eased medication administration challenges.
Area of Science:
- Pediatric infectious diseases
- Public health interventions
- Quality of life research
Background:
- Home-based treatment for pediatric HIV and tuberculous meningitis (TBM) requires effective support interventions.
- Optimizing adherence and quality of life (QoL) are critical for managing chronic pediatric infections.
Purpose of the Study:
- To evaluate a culturally sensitive, low-cost treatment-support intervention for children (0-14 years) undergoing home-based therapy for HIV or TBM.
- To assess the intervention's impact on treatment adherence, medication administration difficulties, health-related quality of life (HRQoL), and family impact.
Main Methods:
- A randomized-controlled trial compared standard care with standard care plus a multifaceted intervention (adherence education, reinforcement, monitoring).
- Adherence was measured via self-report, pill counts, and drug assays. Medication administration difficulties and HRQoL were assessed using validated questionnaires.
- Follow-up periods were 6 months for HIV and 3 months for TBM.
Main Results:
- In the HIV group, the intervention group showed significantly higher HRQoL scores (P = 0.009) and family impact scores (P = 0.040).
- Caregiver disclosure of HIV status increased in both groups, with a greater increase in the intervention group (P < 0.001).
- In the TBM group, the intervention group maintained HRQoL scores, while controls showed a decrease (P = 0.063). Medication administration difficulties decreased in controls (P=0.043).
Conclusions:
- The intervention demonstrated positive effects on HRQoL and family impact for children with HIV.
- The program also improved caregiver disclosure of HIV status and reduced reported difficulties in medication administration.
- Treatment adherence for isoniazid, rifampicin, and pyrazinamide was not significantly altered by the intervention in either the HIV or TBM groups.
Objectives:
To evaluate a paediatric treatment-support intervention for home-based treatment of HIV infection or tuberculous meningitis (TBM).
Methods:
A randomised-controlled study comparing local standard care (controls) with standard care plus intervention (combining adherence education, reinforcement and monitoring) in children aged 0-14 years. We recorded adherence measures (self-report, pill-count, drug-assays for isoniazid and rifampicin in urine and pyrazinamide in saliva), difficulties administering medication and PedsQL™questionnaires for health-related quality-of-life (HRQoL) and family impact.
Results:
In the HIV group (6-months follow-up, n = 195), more children had above-median HRQoL-scores in the intervention group than in the control group (P = 0.009). Problems reported administering medication declined between baseline and follow-up for controls (P = 0.043). Disclosure of HIV status to the child increased between baseline and follow-up in both groups (intervention P < 0.001; control P = 0.031). In the TBM group (3-months follow-up, n = 43), all adherence measures remained high for both intervention and controls, except for rifampicin which declined between baseline and follow-up in the intervention group (P = 0.031). The intervention group maintained above median HRQoL-scores between baseline and follow-up, when the number of children with above-median HRQoL-scores decreased in the controls (P = 0.063). More children in the intervention group had above-median family impact-scores than controls (P = 0.040).
Conclusions:
The low-cost, culturally friendly treatment-support intervention had beneficial effects on health-related quality of life, family impact, caregiver disclosure of HIV status to the child, increased caregiver reporting of medication non-adherence and caregiver reporting of difficulties administering medication. Treatment adherence was not significantly affected in either HIV or TBM group.
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