Document Detail


Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda.
MedLine Citation:
PMID:  21781419     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy.
AIM: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations.
METHODS: HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University-Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ⩾95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA(®) version 10.0.
RESULTS: A total of 129 HIV-infected children were initiated on HAART with 14·7% on syrups and 85·3% on tablet formulations at enrollment. According to caregiver self-reporting, 99·2%, 100%, 100% and 99·2% achieved ⩾95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89·9%, 95·4%, 93·8% and 93·0% and for unannounced home visits were 89·8%, 92·4%, 88·9% and 86·2%, respectively. Median adherence to syrup formulations (97%, IQR 93-98) was significantly lower than for tablets (100%, IQR 97-100, p = 0·012, n = 28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data.
CONCLUSION: The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.
Authors:
A Bagenda; L Barlow-Mosha; D Bagenda; R Sakwa; M G Fowler; P M Musoke
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Annals of tropical paediatrics     Volume:  31     ISSN:  1465-3281     ISO Abbreviation:  Ann Trop Paediatr     Publication Date:  2011  
Date Detail:
Created Date:  2011-07-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8210625     Medline TA:  Ann Trop Paediatr     Country:  England    
Other Details:
Languages:  eng     Pagination:  235-45     Citation Subset:  IM    
Affiliation:
Makerere University-Johns Hopkins University Research Collaboration, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
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