This article was downloaded by: [Colorado College] On: 08 October 2014, At: 18:03 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
African Journal of AIDS Research Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/raar20
Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria Mariya Mukhtar-Yola , Solomon Adeleke , Dayyabu Gwarzo & Zubaida Farouk Ladan Published online: 11 Nov 2009.
To cite this article: Mariya Mukhtar-Yola , Solomon Adeleke , Dayyabu Gwarzo & Zubaida Farouk Ladan (2006) Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria, African Journal of AIDS Research, 5:2, 141-144, DOI: 10.2989/16085900609490374 To link to this article: http://dx.doi.org/10.2989/16085900609490374
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Copyright © NISC Pty Ltd
African Journal of AIDS Research 2006, 5(2): 141–144 Printed in South Africa — All rights reserved
AJAR EISSN 1727–9445
Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria Mariya Mukhtar-Yola1*, Solomon Adeleke1, Dayyabu Gwarzo 2 and Zubaida Farouk Ladan 2 1
Downloaded by [Colorado College] at 18:03 08 October 2014
Department of Paediatrics, Aminu Kano Teaching Hospital, No 3 Hospital Road, Kano State PMB 3452, Nigeria; Bayero University, Kano, Kano State PMB 3452, Nigeria 2 Aminu Kano Teaching Hospital, No 3 Hospital Road, Kano State PMB 3452, Nigeria * Corresponding author, e-mail: [email protected] Treatment of HIV with highly active antiretroviral therapy (HAART) has resulted in declining morbidity and mortality rates from HIV-associated diseases, but concerns regarding access and adherence are growing. To determine the adherence level and the reasons for non-adhering to antiretroviral therapy (ART) among children attending the clinic for infectious diseases at Aminu Kano Teaching Hospital in Nigeria, a cross-sectional study using the selfreport tool was carried out among 40 children with HIV infection who had been on ART for at least six months. Thirty-two patients (80%) were 95% or more adherent to their medications. The most common reasons for nonadherence were running out of medicines and the inability to purchase more due to financial constraints; other barriers were non-availability and inaccessibility to medications. Eighty-five percent of the paediatric patients took their medications at the same time everyday, and scheduled appointments were kept by 87.5%. The social class of the patients did not significantly affect adherence level. The level of adherence to ART was comparable to levels reported from other developing and developed countries. The cost of ART, and availability and accessibility to medications were the most significant barriers to adherence. Expanded access to subsidised antiretroviral drugs should improve adherence — and consequently treatment outcomes — for patients receiving this treatment in resource-poor settings. Keywords: Africa, care in resource-limited settings, HAART, HIV/AIDS, paediatrics, self-report, therapy management
Introduction Adherence to antiretroviral therapy (ART) is critical to treatment outcomes (Bangsberg, Hecht, Charleboise, Zolopa, Holodny, Sheiner, Bamberger, Chesney & Moss, 2000). Medication adherence in HIV care specifically refers to the ability of the person living with HIV/AIDS to be involved in choosing, starting, managing and maintaining a given therapeutic combination to control viral replication and improve immune function (Asim, 2004). Therefore, adherence is a matter of mutual decision-making: the patient understands and, together with the doctor, agrees to make behaviour changes to improve his or her health. In contrast, compliance is defined as a situation where the patient acts according to the command of the doctor or nurse and takes medications as told and without question (Asim, 2004). Adherence has various components, such as consistent and correct dosing of medications, attending healthcare appointments, observing storage requirements, and keeping to timing for medications and food requirements (Bartlett, 2002). Adherence to most drug regimens for chronic diseases is poor across all populations (Bartlett, 2002). With HIV treatment medicines, ≥95% adherence is necessary for viral suppression (namely, 95% of prescribed doses) Number Adherent* Non-adherent
32 8
Table 3: Reasons given by 40 caregivers/child patients for missing doses of antiretroviral medicines
Downloaded by [Colorado College] at 18:03 08 October 2014
Reason Cost Child slept through a dose Forgot Travelled Side-effects Medicine not working Didn’t understand Too many pills Change in routine Depressed
Number 10 1 2 2 0 0 0 0 0 0
last longer. Thirty-eight responders (95%) said the drugs were not shared with other siblings, but two caregivers attested to sharing the child patient’s drugs with a sibling who did not have his or her own drugs. Thirty-four caregivers/patients (85%) were able to administer/take their medications at the same time every day. Most patients (35) were able to keep their monthly appointments as scheduled; however, monthly appointments could not be kept by five patients, who said they did not come to the clinic until 2–4 appointments had been missed. Table 4 lists the external barriers to treatment that the patients/caregivers reported. The most common reason was financial constraint. Discussion Lack of strict adherence to highly active antiretroviral therapy (HAART) is considered a key challenge to AIDS care worldwide. In this study 80% of the patients were 95% or more adherent, according to self-reports. Similarly high levels of adherence have been reported from resource-poor settings in Senegal and Uganda (78% and 66% adherence, respectively) (Laurent, Diakhate, Fatou, Gueye, Toure, Sow & Faye, 2002; Byakika et al., 2005). In another study in the United States, where self-reports, viral load assay and pharmacy-refill monitoring were used to measure adherence in 26 children under age 13, adherence was 100% based on a paediatric AIDS clinical trial group (PACTG) self-report measure, 81% based on electronic monitoring of medicine bottlecap opening, and 79% based on pharmacy refills (Marhefka et al., 2004). Data from electronic monitoring of medicine bottlecap opening and pharmacy refills were both significantly related to patients’ viral load. Marhefka et al. (2004) concluded that the PACTG adherence measure might overestimate adherence. Nevertheless, structured self-reporting has been reliably associated with both objective measures of adherence and viral load in
resource-rich and resource-poor settings (see Olusanya et al., 1985; Stephenson, Rowe, Haynes, Macharia & Leon, 1993; Haurich et al., 1999; Murri, Ammasari, Gallicano, De Luga, Cingolani, Jacobson, Wu & Antinori, 2000; Oyugi et al., 2003; Santos, Silver, Pilloto, Ribeiro, Rodrigues & Passos, 2003). In this study the most common reasons given for missing a dose were running out of medication and the inability to purchase more. Other reasons were travelling difficulty, forgetfulness, and children sleeping through the time for their scheduled dose. Financial constraints, and unavailability and inaccessibility to medications were the main barriers to treatment identified by both the adherent and nonadherent groups. Other workers from resource-limited countries have similarly reported these same factors as adherence barriers (Ammasari, Murri & Pezzotti, 2003; Asim, 2004; Byakika et al., 2005). The social class of the patients did not significantly affect their level of adherence. Even though cost was identified as a barrier to treatment in our patients, those from the middle and lower social class who were able to buy their medication were just as adherent as patients from the upper social class. This is probably due to the monetary sacrifice they made to purchase their medications and also to the ongoing adherence counselling that patients get with every clinic visit. Data from studies in other African settings also suggest that patients of low socio-economic status are able to achieve excellent rates of adherence with access to routine medical care, subsidised ART and free lab monitoring (Asim, 2004). In a recent cohort study of antiretroviral adherence in semiurban South Africans living in extreme poverty, Orrell, Bangsberg, Badri & Wood (2003) found that lower socioeconomic status was not a predictor of adherence among patients receiving fully subsidised therapy. In fact, adherence levels were similar to or better than those found in industrialised countries. Side-effects did not pose a barrier to adherence in this study. According to Ammasari et al. (2003), this finding is in contrast to recent studies in resource-rich settings where the side-effects of medications have been a significant predictor of adherence. Our patients may have been more accepting of drug-related side-effects than their counterparts in resource-rich settings due to the financial sacrifice required to secure therapy, and/or they may have possibly been less able to distinguish side-effects and actual symptoms due to their compromised health. We recognise several methodological limitations to this preliminary study. First, we measured adherence only through a caregiver/patient self-report measure, while the literature suggests that patients tend to overestimate adherence using this tool (Marhefka et al., 2004). Secondly, we were unable to corroborate patient self-report of adherence with viral load assays and CD4 cell counts because of financial and logistic barriers. Thirdly, the small number of patients (40) involved in the study may not adequately represent the adherence pattern of a larger population of children. Nevertheless, we suggest the study provides insight into the problem of non-adherence in this environment, while a larger multifaceted study is needed to give a more representative picture.
144
Mukhtar-Yola, Adeleke, Gwarzo and Ladan
Table 4: Barriers to medication adherence as reported by 40 caregivers/child patients (*some gave more than one reason as a barrier) Barriers*
Downloaded by [Colorado College] at 18:03 08 October 2014
Finances Availability of medicines Accessibility to medicines
Number 23 13 6
In conclusion, the adherence level of paediatric patients at the teaching hospital appeared comparable to that in many developing and developed countries, despite the fact that patients in Nigeria face large structural and economic barriers to antiretroviral treatment. The caregivers in this study reported that the cost of medications was the most significant barrier to treatment. Expanded access to subsidised ART should improve adherence — and consequently treatment outcomes — for child patients receiving treatment in resource-poor settings. The authors — Dr Mariya Mukhtar-Yola is a consultant paediatrician and lecturer, with a special interest in neonatal medicine and infectious diseases. Dr Solomon Ibiyemi Adeleke is a consultant paediatrician and lecturer; his special interests are nephrology and infectious diseases. Dr Dayyabu Gwarzo is a senior hospital registrar, with an interest in haematology and infectious diseases. Dr Zubaida Farouk Ladan is a senior hospital registrar, interested in neonatal medicine and infectious diseases.
References Ammasari, A., Murri, R. & Pezzotti, P. (2003) Long-term follow-up of a cohort of patients under HAART in Senegal. Paper presented at the 10th Conference on Retroviruses and Opportunistic Infections, Boston, USA. Asim, A.J. (2004) Adherence to HIV Treatment Regimens. Recommendations for Best Practices, June 2004. Washington, D.C., American Public Health Association. Available at: www. apha.org. Bangsberg, D., Hecht, F., Charleboise, E., Zolopa, A.R., Holodny, M., Sheiner, L., Bamberger, J., Chesney, M. & Moss, A. (2000) Adherence to protease inhibitors, HIV-1 viral load and development of drug resistance in an indigent population. AIDS 14, pp. 357–366. Bartlett, J. (2002) Addressing the challenge of adherence. Journal of Acquired Immune Deficiency Syndrome 29, pp. 2–10. Byakika, J., Oyugi, J.H., Turnwikirize, W.A., Katabira, E.T., Mugyennyi, P.N. & Bangsberg, D.R. (2005) Adherence to HIV antiretroviral therapy in Ugandan HIV-positive patients purchasing therapy.
International Journal of STD and AIDS 16, pp. 38–41. Haurich, R.H., Little, S.J. & Currier, J.S. (1999) The value of patient reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Groups. AIDS 13, pp. 1099–1107. Katko, E., Johnson, G.M., Fowler, S.L., Johnson, G.M. & Turner, R.B. (2001) Assessment of adherence with medications in HIVinfected children. Paediatric Infectious Disease Journal 20(12), pp. 174–176. Laurent, C., Diakhate, N., Fatou, N., Gueye, N.F., Toure, M.A., Sow, P.S. & Faye, M.A. (2002) The Senegalese government’s highly active antiretroviral therapy initiative: 18-month follow-up. AIDS 16, pp. 1361–1370. Marhefka, S.L., Farley, J.J., Rodrique, J.R., Sandrik, L.L., Sleasman, J.W. & Tepper, V.J. (2004) Clinical assessment of medication adherence among HIV-infected children: examination of the treatment interview protocol (TIP). AIDS Care 16(3), pp. 323– 337. Murri, R., Ammasari, A., Gallicano, K., De Luga, A., Cingolani, A., Jacobson, D., Wu, A.W. & Antinori, A. (2000) Patient-reported non-adherence to HAART is related to protease inhibitor levels. Journal of Acquired Immune Deficiency Syndrome 24, pp. 123– 128. Olusanya, O., Okpere, E.E. & Ezimokhai, M. (1985) The importance of social class in voluntary fertility control in a developing country. West African Journal of Medicine 4, pp. 205–206. Orrell, C., Bangsberg, D., Badri, M.R. & Wood, R. (2003) Adheence is not a barrier to successful antiretroviral therapy in South Africa. AIDS 17, pp. 1369–1375. Oyugi, J., Byakika-Tusiime, J., Mugyenyi, P., Mugerwa, R., Guzman, D., Charleboise, E. & Bangsberg, D. (2003) Self-reported adherence measures are feasible and valid compared to multiple objective measures in Kampala, Uganda. Abstract presented at the Second IAS Conference on HIV Pathogenesis and Treatment, Paris, 13 July 2003. Santos, N., Silver, S., Pilloto, J.H., Ribeiro, J.E., Rodrigues, A. & Passos, S. (2003) Predictors of self-reported adherence to ART in AIDS outpatients. Abstract presented at the Second International AIDS Conference on HIV Pathogenesis and Treatment, Paris, 13 July 2003. SPSS (Statistical Package for Social Sciences) (Released 1999) SPSS for Windows, Version 10. Chicago, SPSS Inc. Stephenson, B.J., Rowe, B.H. Haynes, R.B., Macharia, W.M. & Leon, G. (1993) The rational clinical examination: Is this patient taking treatment as prescribed? JAMA 269, pp. 2779–2781. UNAIDS (2005) AIDS Epidemic Update, December 2005. Weiser, S., Wolfe, W., Bangsberg, D., Ibou, T., Gilbert, P., Makhema, J., Kebaabetswe, P., Dickenson, D., Mompati, K., Essx, M. & Marlink, R. (2003) Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. Journal of Acquired Immune Deficiency Syndromes 34(3), pp. 281–288.
African Journal of AIDS Research Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/raar20
Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria Mariya Mukhtar-Yola , Solomon Adeleke , Dayyabu Gwarzo & Zubaida Farouk Ladan Published online: 11 Nov 2009.
To cite this article: Mariya Mukhtar-Yola , Solomon Adeleke , Dayyabu Gwarzo & Zubaida Farouk Ladan (2006) Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria, African Journal of AIDS Research, 5:2, 141-144, DOI: 10.2989/16085900609490374 To link to this article: http://dx.doi.org/10.2989/16085900609490374
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Copyright © NISC Pty Ltd
African Journal of AIDS Research 2006, 5(2): 141–144 Printed in South Africa — All rights reserved
AJAR EISSN 1727–9445
Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria Mariya Mukhtar-Yola1*, Solomon Adeleke1, Dayyabu Gwarzo 2 and Zubaida Farouk Ladan 2 1
Downloaded by [Colorado College] at 18:03 08 October 2014
Department of Paediatrics, Aminu Kano Teaching Hospital, No 3 Hospital Road, Kano State PMB 3452, Nigeria; Bayero University, Kano, Kano State PMB 3452, Nigeria 2 Aminu Kano Teaching Hospital, No 3 Hospital Road, Kano State PMB 3452, Nigeria * Corresponding author, e-mail: [email protected] Treatment of HIV with highly active antiretroviral therapy (HAART) has resulted in declining morbidity and mortality rates from HIV-associated diseases, but concerns regarding access and adherence are growing. To determine the adherence level and the reasons for non-adhering to antiretroviral therapy (ART) among children attending the clinic for infectious diseases at Aminu Kano Teaching Hospital in Nigeria, a cross-sectional study using the selfreport tool was carried out among 40 children with HIV infection who had been on ART for at least six months. Thirty-two patients (80%) were 95% or more adherent to their medications. The most common reasons for nonadherence were running out of medicines and the inability to purchase more due to financial constraints; other barriers were non-availability and inaccessibility to medications. Eighty-five percent of the paediatric patients took their medications at the same time everyday, and scheduled appointments were kept by 87.5%. The social class of the patients did not significantly affect adherence level. The level of adherence to ART was comparable to levels reported from other developing and developed countries. The cost of ART, and availability and accessibility to medications were the most significant barriers to adherence. Expanded access to subsidised antiretroviral drugs should improve adherence — and consequently treatment outcomes — for patients receiving this treatment in resource-poor settings. Keywords: Africa, care in resource-limited settings, HAART, HIV/AIDS, paediatrics, self-report, therapy management
Introduction Adherence to antiretroviral therapy (ART) is critical to treatment outcomes (Bangsberg, Hecht, Charleboise, Zolopa, Holodny, Sheiner, Bamberger, Chesney & Moss, 2000). Medication adherence in HIV care specifically refers to the ability of the person living with HIV/AIDS to be involved in choosing, starting, managing and maintaining a given therapeutic combination to control viral replication and improve immune function (Asim, 2004). Therefore, adherence is a matter of mutual decision-making: the patient understands and, together with the doctor, agrees to make behaviour changes to improve his or her health. In contrast, compliance is defined as a situation where the patient acts according to the command of the doctor or nurse and takes medications as told and without question (Asim, 2004). Adherence has various components, such as consistent and correct dosing of medications, attending healthcare appointments, observing storage requirements, and keeping to timing for medications and food requirements (Bartlett, 2002). Adherence to most drug regimens for chronic diseases is poor across all populations (Bartlett, 2002). With HIV treatment medicines, ≥95% adherence is necessary for viral suppression (namely, 95% of prescribed doses) Number Adherent* Non-adherent
32 8
Table 3: Reasons given by 40 caregivers/child patients for missing doses of antiretroviral medicines
Downloaded by [Colorado College] at 18:03 08 October 2014
Reason Cost Child slept through a dose Forgot Travelled Side-effects Medicine not working Didn’t understand Too many pills Change in routine Depressed
Number 10 1 2 2 0 0 0 0 0 0
last longer. Thirty-eight responders (95%) said the drugs were not shared with other siblings, but two caregivers attested to sharing the child patient’s drugs with a sibling who did not have his or her own drugs. Thirty-four caregivers/patients (85%) were able to administer/take their medications at the same time every day. Most patients (35) were able to keep their monthly appointments as scheduled; however, monthly appointments could not be kept by five patients, who said they did not come to the clinic until 2–4 appointments had been missed. Table 4 lists the external barriers to treatment that the patients/caregivers reported. The most common reason was financial constraint. Discussion Lack of strict adherence to highly active antiretroviral therapy (HAART) is considered a key challenge to AIDS care worldwide. In this study 80% of the patients were 95% or more adherent, according to self-reports. Similarly high levels of adherence have been reported from resource-poor settings in Senegal and Uganda (78% and 66% adherence, respectively) (Laurent, Diakhate, Fatou, Gueye, Toure, Sow & Faye, 2002; Byakika et al., 2005). In another study in the United States, where self-reports, viral load assay and pharmacy-refill monitoring were used to measure adherence in 26 children under age 13, adherence was 100% based on a paediatric AIDS clinical trial group (PACTG) self-report measure, 81% based on electronic monitoring of medicine bottlecap opening, and 79% based on pharmacy refills (Marhefka et al., 2004). Data from electronic monitoring of medicine bottlecap opening and pharmacy refills were both significantly related to patients’ viral load. Marhefka et al. (2004) concluded that the PACTG adherence measure might overestimate adherence. Nevertheless, structured self-reporting has been reliably associated with both objective measures of adherence and viral load in
resource-rich and resource-poor settings (see Olusanya et al., 1985; Stephenson, Rowe, Haynes, Macharia & Leon, 1993; Haurich et al., 1999; Murri, Ammasari, Gallicano, De Luga, Cingolani, Jacobson, Wu & Antinori, 2000; Oyugi et al., 2003; Santos, Silver, Pilloto, Ribeiro, Rodrigues & Passos, 2003). In this study the most common reasons given for missing a dose were running out of medication and the inability to purchase more. Other reasons were travelling difficulty, forgetfulness, and children sleeping through the time for their scheduled dose. Financial constraints, and unavailability and inaccessibility to medications were the main barriers to treatment identified by both the adherent and nonadherent groups. Other workers from resource-limited countries have similarly reported these same factors as adherence barriers (Ammasari, Murri & Pezzotti, 2003; Asim, 2004; Byakika et al., 2005). The social class of the patients did not significantly affect their level of adherence. Even though cost was identified as a barrier to treatment in our patients, those from the middle and lower social class who were able to buy their medication were just as adherent as patients from the upper social class. This is probably due to the monetary sacrifice they made to purchase their medications and also to the ongoing adherence counselling that patients get with every clinic visit. Data from studies in other African settings also suggest that patients of low socio-economic status are able to achieve excellent rates of adherence with access to routine medical care, subsidised ART and free lab monitoring (Asim, 2004). In a recent cohort study of antiretroviral adherence in semiurban South Africans living in extreme poverty, Orrell, Bangsberg, Badri & Wood (2003) found that lower socioeconomic status was not a predictor of adherence among patients receiving fully subsidised therapy. In fact, adherence levels were similar to or better than those found in industrialised countries. Side-effects did not pose a barrier to adherence in this study. According to Ammasari et al. (2003), this finding is in contrast to recent studies in resource-rich settings where the side-effects of medications have been a significant predictor of adherence. Our patients may have been more accepting of drug-related side-effects than their counterparts in resource-rich settings due to the financial sacrifice required to secure therapy, and/or they may have possibly been less able to distinguish side-effects and actual symptoms due to their compromised health. We recognise several methodological limitations to this preliminary study. First, we measured adherence only through a caregiver/patient self-report measure, while the literature suggests that patients tend to overestimate adherence using this tool (Marhefka et al., 2004). Secondly, we were unable to corroborate patient self-report of adherence with viral load assays and CD4 cell counts because of financial and logistic barriers. Thirdly, the small number of patients (40) involved in the study may not adequately represent the adherence pattern of a larger population of children. Nevertheless, we suggest the study provides insight into the problem of non-adherence in this environment, while a larger multifaceted study is needed to give a more representative picture.
144
Mukhtar-Yola, Adeleke, Gwarzo and Ladan
Table 4: Barriers to medication adherence as reported by 40 caregivers/child patients (*some gave more than one reason as a barrier) Barriers*
Downloaded by [Colorado College] at 18:03 08 October 2014
Finances Availability of medicines Accessibility to medicines
Number 23 13 6
In conclusion, the adherence level of paediatric patients at the teaching hospital appeared comparable to that in many developing and developed countries, despite the fact that patients in Nigeria face large structural and economic barriers to antiretroviral treatment. The caregivers in this study reported that the cost of medications was the most significant barrier to treatment. Expanded access to subsidised ART should improve adherence — and consequently treatment outcomes — for child patients receiving treatment in resource-poor settings. The authors — Dr Mariya Mukhtar-Yola is a consultant paediatrician and lecturer, with a special interest in neonatal medicine and infectious diseases. Dr Solomon Ibiyemi Adeleke is a consultant paediatrician and lecturer; his special interests are nephrology and infectious diseases. Dr Dayyabu Gwarzo is a senior hospital registrar, with an interest in haematology and infectious diseases. Dr Zubaida Farouk Ladan is a senior hospital registrar, interested in neonatal medicine and infectious diseases.
References Ammasari, A., Murri, R. & Pezzotti, P. (2003) Long-term follow-up of a cohort of patients under HAART in Senegal. Paper presented at the 10th Conference on Retroviruses and Opportunistic Infections, Boston, USA. Asim, A.J. (2004) Adherence to HIV Treatment Regimens. Recommendations for Best Practices, June 2004. Washington, D.C., American Public Health Association. Available at: www. apha.org. Bangsberg, D., Hecht, F., Charleboise, E., Zolopa, A.R., Holodny, M., Sheiner, L., Bamberger, J., Chesney, M. & Moss, A. (2000) Adherence to protease inhibitors, HIV-1 viral load and development of drug resistance in an indigent population. AIDS 14, pp. 357–366. Bartlett, J. (2002) Addressing the challenge of adherence. Journal of Acquired Immune Deficiency Syndrome 29, pp. 2–10. Byakika, J., Oyugi, J.H., Turnwikirize, W.A., Katabira, E.T., Mugyennyi, P.N. & Bangsberg, D.R. (2005) Adherence to HIV antiretroviral therapy in Ugandan HIV-positive patients purchasing therapy.
International Journal of STD and AIDS 16, pp. 38–41. Haurich, R.H., Little, S.J. & Currier, J.S. (1999) The value of patient reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Groups. AIDS 13, pp. 1099–1107. Katko, E., Johnson, G.M., Fowler, S.L., Johnson, G.M. & Turner, R.B. (2001) Assessment of adherence with medications in HIVinfected children. Paediatric Infectious Disease Journal 20(12), pp. 174–176. Laurent, C., Diakhate, N., Fatou, N., Gueye, N.F., Toure, M.A., Sow, P.S. & Faye, M.A. (2002) The Senegalese government’s highly active antiretroviral therapy initiative: 18-month follow-up. AIDS 16, pp. 1361–1370. Marhefka, S.L., Farley, J.J., Rodrique, J.R., Sandrik, L.L., Sleasman, J.W. & Tepper, V.J. (2004) Clinical assessment of medication adherence among HIV-infected children: examination of the treatment interview protocol (TIP). AIDS Care 16(3), pp. 323– 337. Murri, R., Ammasari, A., Gallicano, K., De Luga, A., Cingolani, A., Jacobson, D., Wu, A.W. & Antinori, A. (2000) Patient-reported non-adherence to HAART is related to protease inhibitor levels. Journal of Acquired Immune Deficiency Syndrome 24, pp. 123– 128. Olusanya, O., Okpere, E.E. & Ezimokhai, M. (1985) The importance of social class in voluntary fertility control in a developing country. West African Journal of Medicine 4, pp. 205–206. Orrell, C., Bangsberg, D., Badri, M.R. & Wood, R. (2003) Adheence is not a barrier to successful antiretroviral therapy in South Africa. AIDS 17, pp. 1369–1375. Oyugi, J., Byakika-Tusiime, J., Mugyenyi, P., Mugerwa, R., Guzman, D., Charleboise, E. & Bangsberg, D. (2003) Self-reported adherence measures are feasible and valid compared to multiple objective measures in Kampala, Uganda. Abstract presented at the Second IAS Conference on HIV Pathogenesis and Treatment, Paris, 13 July 2003. Santos, N., Silver, S., Pilloto, J.H., Ribeiro, J.E., Rodrigues, A. & Passos, S. (2003) Predictors of self-reported adherence to ART in AIDS outpatients. Abstract presented at the Second International AIDS Conference on HIV Pathogenesis and Treatment, Paris, 13 July 2003. SPSS (Statistical Package for Social Sciences) (Released 1999) SPSS for Windows, Version 10. Chicago, SPSS Inc. Stephenson, B.J., Rowe, B.H. Haynes, R.B., Macharia, W.M. & Leon, G. (1993) The rational clinical examination: Is this patient taking treatment as prescribed? JAMA 269, pp. 2779–2781. UNAIDS (2005) AIDS Epidemic Update, December 2005. Weiser, S., Wolfe, W., Bangsberg, D., Ibou, T., Gilbert, P., Makhema, J., Kebaabetswe, P., Dickenson, D., Mompati, K., Essx, M. & Marlink, R. (2003) Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. Journal of Acquired Immune Deficiency Syndromes 34(3), pp. 281–288.
