Adherence to Antiretroviral Therapy and associated factors among HIV infected children in Ethiopia: unannounced home-based pill count versus caregivers' report.
Adherence to Antiretroviral Therapy and associated factors among HIV infected children in Ethiopia: unannounced home-based pill count versus caregivers' report.
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DOI：
10.1186/1471-2431-13-132
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发表时间：
2013-09-02
期刊：
影响因子：
2.4
通讯作者：
Belay M
中科院分区：
文献类型：
--
作者：
Biressaw S;Abegaz WE;Abebe M;Taye WA;Belay M
抗逆转录病毒疗法（ART）的引入显著降低了感染艾滋病毒/艾滋病的成人和儿童与艾滋病毒相关的死亡率和发病率。坚持抗逆转录病毒治疗是成功治疗患者和遏制耐药性的关键。基于护理人员报告的研究表明，儿童坚持抗逆转录病毒治疗的情况总体良好。然而，主观的方法，如护理人员的报告，被认为高估了依从性的水平。本研究确定了依从率及其预测因素，使用未公布的家庭药丸计数，并将结果与埃塞俄比亚三级转诊医院护理人员的报告进行了比较。横断面研究于2011年12月1日至2012年1月30日进行。研究参与者是在亚的斯亚贝巴大学蒂库尔安贝萨医院（TAH）儿科ART诊所接受ART治疗的210名儿童及其护理人员。在ART诊所使用结构化问卷对护理人员进行访谈。然后，在访谈后7天，不事先通知的家庭药片计数。照护者在访谈前7天报告的依从性为93.3%。然而，使用未公布的家庭用药剂量的依从性估计为34.8%。在多变量logistic回归模型中，已婚[aOR = 7.85 (95% CI: 2.11,29.13)]和丧偶/离婚[aOR = 7.14 (95% CI: 2.00,25.46)]照顾者、不知道自己HIV血清状态的儿童[aOR = 2.35 (95% CI:1.09, 5.06)]和基线who临床III/IV期[OR = 3.18 （95% CI: 1.21, 8.40）的儿童更有可能坚持抗逆转录病毒治疗。另一方面，d4T/3Tc/EFV联合治疗的儿童[OR = 0.10 (95% CI: 0.02, 0.53)]坚持治疗的可能性较小。据报道，看护人的健忘和孩子拒绝服药是错过剂量的主要原因。基于未公布的家庭药丸数量的依从性水平低得令人无法接受。迫切需要采取干预措施，以提高在TAH接受抗逆转录病毒治疗的儿童的依从性。此外，还需要一项结合临床参数（病毒载量和CD4计数）测量依从性的纵向研究，以确定研究区域内简单可靠的依从性测量方法。
The introduction of Antiretroviral Therapy (ART) has brought a remarkable reduction in HIV-related mortality and morbidity both in adults and children living with HIV/AIDS. Adherence to ART is the key to the successful treatment of patients as well as containment of drug resistance. Studies based on caregivers’ report have shown that adherence to ART among children is generally good. However, subjective methods such as caregivers’ report are known to overestimate the level of adherence. This study determined the rate of adherence and its predictors using unannounced home-based pill count and compared the result with caregivers’ report in a tertiary referral hospital in Ethiopia. A cross-sectional study was conducted between December 1, 2011 and January 30, 2012. The study participants were 210 children on ART and their caregivers attending pediatric ART clinic of Tikur Anbessa Hospital (TAH), Addis Ababa University. Caregivers were interviewed at the ART clinic using a structured questionnaire. Then, unannounced home-based pill count was done 7 days after the interview. Caregiver-reported adherence in the past 7 days prior to interview was 93.3%. Estimated adherence using unannounced home-based pill count was found, however, to be 34.8%. On multivariate logistic regression model, children with married [aOR = 7.85 (95% CI: 2.11,29.13)] and widowed/divorced [aOR = 7.14 (95% CI: 2.00,25.46)] caregivers, those who were not aware of their HIV sero-status [aOR = 2.35 (95% CI:1.09, 5.06)], and those with baseline WHO clinical stage III/IV [OR = 3.18 (95% CI: 1.21, 8.40] were more likely to adhere to their ART treatment. On the other hand, children on d4T/3Tc/EFV combination [OR = 0.10 (95% CI: 0.02, 0.53)] were less likely to adhere to their treatment. Caregivers’ forgetfulness and child refusal to take medication were reported as the major reasons for missing doses. The level of adherence based on unannounced home-based pill count was unacceptably low. Interventions are urgently needed to improve adherence to ART among children at TAH. Besides, a longitudinal study measuring adherence combined with clinical parameters (viral load and CD4 count) is needed to identify a simple and reliable measure of adherence in the study area.
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3.8
作者：
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