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

• Published in: PloS one 2018-02, Vol.13 (2), p.e0191848-e0191848
• Main Authors: 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
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; Adolescent; Africa, Eastern; AIDS; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biology and Life Sciences; Child; Child, Preschool; Children; Cohort analysis; Confidence intervals; Consortia; Data processing; Dosage and administration; Drug therapy; Epidemiology; Evaluation; Female; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infant; Male; Medicine and Health Sciences; Mortality; Patient Compliance; Patients; Pediatric HIV infections; Pediatrics; People and Places; Recall; Regression analysis; Regression models; Social Sciences; Statistical analysis; Therapy; Variability
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0191848

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. 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. 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]). 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.