Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa

Rachel Vreeman, Samuel O. Ayaya, Beverly S. Musick, Constantin Yiannoutsos, Craig R. Cohen, Denis Nash, Deo Wabwire, Kara Wools-Kaloustian, Sarah Wiehe

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Objective To describe antiretroviral therapy (ART) adherence and associated factors for a large HIV-infected pediatric cohort followed by sites of the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) consortium. Methods This study utilized prospectively collected clinical data from HIV-infected children less than 13 years of age who initiated ART within 4 clinical care programs (with 26 clinical sites) in Kenya, Uganda, and Tanzania and were followed for up to 6 years. Programs used one of 3 adherence measures, including 7-day quantitative recall, 7-day categorical recall, and clinician pill assessments. We fit a hierarchical, three-level, logistic-regression model to examine adherence, with observations nested within patient, and patients within the 26 sites providing pediatric HIV data to this analysis. Results In East Africa, 3,304 children, 52.0% male, were enrolled in care and were subsequently observed for a median of 92 weeks (inter-quartile range [IQR] 50.3–145.0 weeks). Median age at ART initiation was 5.5 years ([IQR] 3.0–8.5 years). “Good” adherence, as reported by each clinic’s measures, was extremely high, remaining on average above 90% throughout all years of follow-up. Longer time on ART was associated with higher adherence (adjusted Odds Ratio–aOR–per log-transformed week on ART: 1.095, 95% Confidence Interval–CI–[1.052–1.150].) Patients enrolled in higher-volume programs exhibited higher rates of clinician-assessed adherence (aOR per log-500 patients: 1.174, 95% CI [1.108–1.245]). Significant site-level variability in reported adherence was observed (0.28), with even higher variability among patients (0.71). In a sub-analysis, being an orphan at the start of ART was strongly associated with lower ART adherence rates (aOR: 0.919, 95% CI [0.864–0.976]). Conclusions Self-reported adherence remained high over a median of 1.8 years in HIV care, but varied according to patient-level and site-level factors. Consistent adherence monitoring with validated measures and attention to vulnerable groups is recommended.

Original languageEnglish (US)
Article numbere0191848
JournalPLoS One
Volume13
Issue number2
DOIs
StatePublished - Feb 1 2018

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Eastern Africa
Pediatrics
HIV
therapeutics
Logistics
Monitoring
Therapeutics
Logistic Models
Orphaned Children
Uganda
Tanzania
Kenya
Acquired Immunodeficiency Syndrome
Databases
monitoring

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa. / Vreeman, Rachel; Ayaya, Samuel O.; Musick, Beverly S.; Yiannoutsos, Constantin; Cohen, Craig R.; Nash, Denis; Wabwire, Deo; Wools-Kaloustian, Kara; Wiehe, Sarah.

In: PLoS One, Vol. 13, No. 2, e0191848, 01.02.2018.

Research output: Contribution to journalArticle

Vreeman, Rachel ; Ayaya, Samuel O. ; Musick, Beverly S. ; Yiannoutsos, Constantin ; Cohen, Craig R. ; Nash, Denis ; Wabwire, Deo ; Wools-Kaloustian, Kara ; Wiehe, Sarah. / Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa. In: PLoS One. 2018 ; Vol. 13, No. 2.
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abstract = "Objective To describe antiretroviral therapy (ART) adherence and associated factors for a large HIV-infected pediatric cohort followed by sites of the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) consortium. Methods This study utilized prospectively collected clinical data from HIV-infected children less than 13 years of age who initiated ART within 4 clinical care programs (with 26 clinical sites) in Kenya, Uganda, and Tanzania and were followed for up to 6 years. Programs used one of 3 adherence measures, including 7-day quantitative recall, 7-day categorical recall, and clinician pill assessments. We fit a hierarchical, three-level, logistic-regression model to examine adherence, with observations nested within patient, and patients within the 26 sites providing pediatric HIV data to this analysis. Results In East Africa, 3,304 children, 52.0{\%} male, were enrolled in care and were subsequently observed for a median of 92 weeks (inter-quartile range [IQR] 50.3–145.0 weeks). Median age at ART initiation was 5.5 years ([IQR] 3.0–8.5 years). “Good” adherence, as reported by each clinic’s measures, was extremely high, remaining on average above 90{\%} throughout all years of follow-up. Longer time on ART was associated with higher adherence (adjusted Odds Ratio–aOR–per log-transformed week on ART: 1.095, 95{\%} Confidence Interval–CI–[1.052–1.150].) Patients enrolled in higher-volume programs exhibited higher rates of clinician-assessed adherence (aOR per log-500 patients: 1.174, 95{\%} CI [1.108–1.245]). Significant site-level variability in reported adherence was observed (0.28), with even higher variability among patients (0.71). In a sub-analysis, being an orphan at the start of ART was strongly associated with lower ART adherence rates (aOR: 0.919, 95{\%} CI [0.864–0.976]). Conclusions Self-reported adherence remained high over a median of 1.8 years in HIV care, but varied according to patient-level and site-level factors. Consistent adherence monitoring with validated measures and attention to vulnerable groups is recommended.",
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