Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects.
Excellent adherence to antiretrovirals in HIV+ Zambian children is compromised by disrupted routine, HIV nondisclosure, and paradoxical income effects.
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DOI：
10.1371/journal.pone.0018505
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发表时间：
2011-04-21
期刊：
影响因子：
3.7
通讯作者：
Bangsberg DR
中科院分区：
文献类型：
--
作者：
Haberer JE;Cook A;Walker AS;Ngambi M;Ferrier A;Mulenga V;Kityo C;Thomason M;Kabamba D;Chintu C;Gibb DM;Bangsberg DR
更好地了解撒哈拉以南非洲地区的儿科抗逆转录病毒治疗（ART）依从性对于制定干预措施以维持高水平的依从性是必要的。采用护理报告、诊所和未通知的家庭用药计数以及药物事件监测系统（MEMS），前瞻性地测量了96名开始接受固定剂量复方ART的赞比亚HIV感染儿童（中位年龄6岁，四分位距[IQR] 2，9）的依从性（中位23个月; IQR 20，26）。在48周时测定HIV-1 RNA。儿童和照顾者的特点，社会人口学状况，和治疗相关因素进行了评估，作为依从性的预测因素。中位依从性为97.4%视觉模拟量表（IQR 96.1，98.4%），94.8%（IQR 86，100%），按患者报告的末次漏服剂量，96.9%（IQR 94.5，98.2%）通过门诊服药计数，93.4%（IQR 90.2，96.7%）通过家庭不公开服药计数，94.8%（IQR 87.8，97.7%）通过MEMS。48周时，72.6%的儿童HIV-1 RNA <50拷贝/ml。依从性指标之间的一致性较差;只有MEMS与病毒抑制显著相关（p = 0.013）。 遵守情况不佳的预测因素包括改变住所、上学、不向9至15岁儿童披露艾滋病毒情况以及家庭收入增加。在撒哈拉以南非洲，接受固定剂量复方抗逆转录病毒疗法的儿童坚持率很高，并持续了两年。然而，某些群体面临治疗失败的风险，包括日常生活被打乱的儿童、年龄较大的儿童不知道自己被诊断出艾滋病毒以及家庭收入相对较高，这可能反映了在更贫穷的情况下社会支持更大。
A better understanding of pediatric antiretroviral therapy (ART) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence. Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9) initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26) with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS). HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4%) by visual analog scale, 94.8% (IQR 86,100%) by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2%) by clinic pill count, 93.4% (IQR 90.2,96.7%) by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7%) by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013). Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income. Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty.
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DOI：
10.1080/09540120050123783
发表时间：
2000-08-01
影响因子：
1.7
作者：
Gao, X;Nau, DP;Woodward, C
通讯作者：
Woodward, C
影响因子：
168.9
作者：
Burns, DN;Mofenson, LM
通讯作者：
Mofenson, LM
影响因子：
4.4
作者：
Byakika-Tusiime, Jayne;Crane, Johanna;Bangsberg, David R.
通讯作者：
Bangsberg, David R.
影响因子：
4.9
作者：
Vaz, Lara M. E.;Eng, Eugenia;Behets, Frieda
通讯作者：
Behets, Frieda
影响因子：
11.8
作者：
Petersen, Maya L.;Wang, Yue;Bangsberg, David R.
通讯作者：
Bangsberg, David R.