Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting

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dc.contributor.advisorLondon, Leslieen_ZA
dc.contributor.advisorEley, Brianen_ZA
dc.contributor.authorMichaels, Desireéen_ZA
dc.date.accessioned2014-11-08T18:08:36Z
dc.date.available2014-11-08T18:08:36Z
dc.date.issued2008en_ZA
dc.descriptionIncludes bibliographical references (p. 212-244).en_ZA
dc.description.abstract[Objectives] There is a paucity of data regarding paediatric adherence in resource-limited settings (RLS) especially among the very young age groups (<7yrs). The study investigated the rates of adherence, the identification of the adherence measurement, amongst four, which best correlates with viral load suppression; as well as correlates of adherence amongst a cohort of children younger than 7 years on antiretroviral HIV treatment. Design: A Prospective cohort study with 6 months follow-up [ Methods ] Measures of adherence used: caregiver self-report (CSR), medicine measure/pill count, pharmacy refill and clinic attendance. Child, caregiver, socio-economic and health service characteristics were assessed for impact on adherence. Bivariate and multivariate analyses were used to determine agreement between measures and viral load outcome and to determine correlates of adherence. [ Results ] Mean age of children enrolled into the study was 27.08 months with a cohort mean adherence rate of 85% and mean viral load suppression of 74% at 6 months. Biological mothers were the majority primary caregivers (85%) and the majority (76%) of caregivers were unemployed with 60% receiving some form of social welfare grant. Results showed that caregiver selfreported adherence (CSR) was significantly correlated with viral load at 6 months (p=0.004). Correlations were found between clinic visits and pharmacy refill (highest values 0.35; p=0.000) and between medicine measure and clinic visits (highest value -0.21; p=0.04) but none of these measures were significantly correlated with viral load. Sensitivity and specificity analysis for CGSR showed that >95% adherence ensured a good viral load outcome. Four factors were significantly associated with adherence in bivariate analyses. These were: access to social welfare grants (OR=2.7; p=0.05); being counselled for initiation of ARV treatment by a counsellor vs. a doctor or nurse (OR 3.2, p=0.03); having another person in the household other than the index child infected with HIV (OR = 0.34, p=0.05) and caregiver depression (OR=0.07, p=0.01). However, in multivariate analyses certain other child, caregiver, socio-economic and health system characteristics as well as the abovementioned variables emerged as significant. [ Conclusion ] Key findings indicate that adherence rates are relatively high in this cohort and CGSR is valid in a resource-poor setting but medicine measure was problematic as a paediatric HAART adherence measure. Certain child, caregiver, socio-economic and health system characteristics have a significant impact on adherence.en_ZA
dc.identifier.apacitationMichaels, D. (2008). <i>Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine. Retrieved from http://hdl.handle.net/11427/9425en_ZA
dc.identifier.chicagocitationMichaels, Desireé. <i>"Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2008. http://hdl.handle.net/11427/9425en_ZA
dc.identifier.citationMichaels, D. 2008. Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Michaels, Desireé AB - [Objectives] There is a paucity of data regarding paediatric adherence in resource-limited settings (RLS) especially among the very young age groups (<7yrs). The study investigated the rates of adherence, the identification of the adherence measurement, amongst four, which best correlates with viral load suppression; as well as correlates of adherence amongst a cohort of children younger than 7 years on antiretroviral HIV treatment. Design: A Prospective cohort study with 6 months follow-up [ Methods ] Measures of adherence used: caregiver self-report (CSR), medicine measure/pill count, pharmacy refill and clinic attendance. Child, caregiver, socio-economic and health service characteristics were assessed for impact on adherence. Bivariate and multivariate analyses were used to determine agreement between measures and viral load outcome and to determine correlates of adherence. [ Results ] Mean age of children enrolled into the study was 27.08 months with a cohort mean adherence rate of 85% and mean viral load suppression of 74% at 6 months. Biological mothers were the majority primary caregivers (85%) and the majority (76%) of caregivers were unemployed with 60% receiving some form of social welfare grant. Results showed that caregiver selfreported adherence (CSR) was significantly correlated with viral load at 6 months (p=0.004). Correlations were found between clinic visits and pharmacy refill (highest values 0.35; p=0.000) and between medicine measure and clinic visits (highest value -0.21; p=0.04) but none of these measures were significantly correlated with viral load. Sensitivity and specificity analysis for CGSR showed that >95% adherence ensured a good viral load outcome. Four factors were significantly associated with adherence in bivariate analyses. These were: access to social welfare grants (OR=2.7; p=0.05); being counselled for initiation of ARV treatment by a counsellor vs. a doctor or nurse (OR 3.2, p=0.03); having another person in the household other than the index child infected with HIV (OR = 0.34, p=0.05) and caregiver depression (OR=0.07, p=0.01). However, in multivariate analyses certain other child, caregiver, socio-economic and health system characteristics as well as the abovementioned variables emerged as significant. [ Conclusion ] Key findings indicate that adherence rates are relatively high in this cohort and CGSR is valid in a resource-poor setting but medicine measure was problematic as a paediatric HAART adherence measure. Certain child, caregiver, socio-economic and health system characteristics have a significant impact on adherence. DA - 2008 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2008 T1 - Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting TI - Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting UR - http://hdl.handle.net/11427/9425 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/9425
dc.identifier.vancouvercitationMichaels D. Paediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor setting. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Public Health and Family Medicine, 2008 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/9425en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Public Health and Family Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherPublic Health and Family Medicineen_ZA
dc.titlePaediatric antiretroviral HIV treatment : measurement and correlates of adherence in a resource-poor settingen_ZA
dc.typeDoctoral Thesis
dc.type.qualificationlevelDoctoral
dc.type.qualificationnamePhDen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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