Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study.
Adherence to antiretroviral therapy in young children in Cape Town, South Africa, measured by medication return and caregiver self-report: a prospective cohort study.
复制标题
DOI：
10.1186/1471-2431-8-34
复制
发表时间：
2008-09-04
期刊：
影响因子：
2.4
通讯作者：
Eley B
中科院分区：
文献类型：
--
作者：
Davies MA;Boulle A;Fakir T;Nuttall J;Eley B
抗逆转录病毒疗法（ART）显著改善了非洲儿童的预后;然而，治疗成功需要良好的依从性。本研究描述了在南非开普敦的婴幼儿中检测失误的不同依从性措施的效用。在一个前瞻性队列的122名艾滋病毒感染儿童开始抗逆转录病毒治疗，坚持每月在治疗的第一年通过药物返回（MR）糖浆和片剂/胶囊。治疗3个月后，对护理人员进行问卷调查，以评估给予药物的经验和自我报告的依从性。在一年结束时评估对治疗的病毒和免疫应答，并确定与测量的依从性的相关性。115/122（94%）例中位年龄（IQR）为37（16 - 61）个月的儿童返回药物治疗。91例（79%）儿童实现了年平均MR依从性≥ 90%。在调整疾病严重程度后，这是与病毒抑制相关的重要协变量（OR = 5.5 [95%CI：0.8-35.6]，p = 0.075），但与抗逆转录病毒治疗的免疫应答无关。在抗逆转录病毒治疗3个月时，13例（10%）儿童死亡，11例（10%）失访。87/98（90%）的照顾者完成了问卷调查。报告的依从性差（前3天内缺失≥ 1剂）对MR依从性<90%的敏感性仅为31.8%（95% CI：10.7% - 53.0%）。33/87名（38.4%）儿童的护理人员报告给药困难，最常见的是适口性差（21.8%）。MR依从性≥ 90%的独立社会人口统计学预测因素是护理人员的中学教育程度（OR = 4.49; 95%CI：1.10 - 18.24）和水电供应（OR = 2.65; 95%CI：0.93 - 7.55）。使用利托那韦与MR依从性≥ 90%呈负相关（OR = 0.37; 95%CI：0.13 - 1.02）。非洲婴儿和幼儿对抗逆转录病毒疗法的依从性很好，MR依从性的相对简单、低技术指标强烈预测了病毒应答。更好的社会经济地位和更可口的方案与更好的依从性相关。
Antiretroviral therapy (ART) dramatically improves outcomes for children in Africa; however excellent adherence is required for treatment success. This study describes the utility of different measures of adherence in detecting lapses in infants and young children in Cape Town, South Africa. In a prospective cohort of 122 HIV-infected children commenced on ART, adherence was measured monthly during the first year of treatment by medication return (MR) for both syrups and tablets/capsules. A questionnaire was administered to caregivers after 3 months of treatment to assess experience with giving medication and self-reported adherence. Viral and immune response to treatment were assessed at the end of one year and associations with measured adherence determined. Medication was returned for 115/122 (94%) children with median age (IQR) of 37 (16 – 61) months. Ninety-one (79%) children achieved annual average MR adherence ≥ 90%. This was an important covariate associated with viral suppression after adjustment for disease severity (OR = 5.5 [95%CI: 0.8–35.6], p = 0.075), however was not associated with immunological response to ART. By 3 months on ART, 13 (10%) children had deceased and 11 (10%) were lost to follow-up. Questionnaires were completed by 87/98 (90%) of caregivers of those who remained in care. Sensitivity of poor reported adherence (missing ≥ 1 dose in the previous 3 days) for MR adherence <90% was only 31.8% (95% CI: 10.7% – 53.0%). Caregivers of 33/87 (38.4%) children reported difficulties with giving medication, most commonly poor palatability (21.8%). Independent socio-demographic predictors of MR adherence ≥ 90% were secondary education of caregivers (OR = 4.49; 95%CI: 1.10 – 18.24) and access to water and electricity (OR = 2.65; 95%CI: 0.93 – 7.55). Taking ritonavir was negatively associated with MR adherence ≥ 90% (OR = 0.37; 95%CI: 0.13 – 1.02). Excellent adherence to ART is possible in African infants and young children and the relatively simple low technology measure of adherence by MR strongly predicts viral response. Better socio-economic status and more palatable regimens are associated with better adherence.
登录
查看更多内容
影响因子：
15.8
作者：
Mills EJ;Nachega JB;Bangsberg DR;Singh S;Rachlis B;Wu P;Wilson K;Buchan I;Gill CJ;Cooper C
通讯作者：
Cooper C
影响因子：
3.8
作者：
Fassinou, P;Elenga, N;Msellati, P
通讯作者：
Msellati, P
影响因子：
39.2
作者：
Liu, HH;Golin, CE;Wenger, NS
通讯作者：
Wenger, NS
影响因子：
3.8
作者：
Rouet, Francois;Fassinou, Patricia;Msellati, Philippe
通讯作者：
Msellati, Philippe
影响因子：
4.4
作者：
Bikaako-Kajura, Winnie;Luyirika, Emmanuel;Bunnell, Rebecca
通讯作者：
Bunnell, Rebecca