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

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

Research output: Contribution to journalArticle

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.

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
odds ratio
confidence interval
Acquired Immunodeficiency Syndrome
Odds Ratio
Databases
Confidence Intervals
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 C.; Ayaya, Samuel O.; Musick, Beverly S.; Yiannoutsos, Constantin T.; Cohen, Craig R.; Nash, Denis; Wabwire, Deo; Wools-Kaloustian, Kara; Wiehe, Sarah E.

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

Research output: Contribution to journalArticle

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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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AU - Cohen,Craig R.

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N2 - 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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