Adherence to antiretroviral therapy and factors affecting adherence among paediatric HIV patients

Kendre Govind, Gabhale Yashwant, Shah Nikita, Jadhav Vishal, Nath Kunal, Manglani Mamta


Background: Adherence to antiretroviral therapy (ART) is the strongest indicator of successful treatment of Human Immunodeficiency Virus (HIV) among children. The main aim of the present study was to know the prevalence of adherence at our centre and various factors affecting the adherence in children.

Methods: It was an observational study done in children less than 15 years of age, affected with HIV.  78 children attending Paediatric Centre of Excellence (PCOE) for HIV L.T.M.G. Hospital, Sion, Mumbai were included in study, Study period was 18 months from January 2012 to June 2013. Complete history of the patients was noted in a pre-designed proforma. Baseline investigations related to HIV were done in all children. Fixed dose combination ART was started in children who fulfilled clinical and/or immunological criteria as per the NACO guidelines. Adherence was estimated using Pill count method..All the data were analysed by using 10.0 version of statistical software SPSS.

Results: In this study, male children (57.7%) out numbered the females (42.3%). Majority of study subjects were more than 10 years of age. Overall adherence among subjects was 82.1% at the end of one year and non-adherence was 17.9%. There was no significant association of age and gender of the patients with adherence (p>0.05). Education, employment and knowledge towards medication of care takers was significantly associated with adherence of ART (p<0.05). Adherence of study cases had not showed any significant association with ART treatment regimen (p=0.99). At the end of one year, the mean CD4 count was significantly more as compared to baseline among adherence group and the mean CD4 count was significantly less as compared to baseline among non-adherence group. The most common reason for missed dosage was forgot to take medicine in 29 subjects (37.1 %)..

Conclusion: Adherence level in this study was good. Forgot to take the medicine was the main reason given by the patients for non-adherence. Education, employment and knowledge towards medication of care takers was significantly associated with adherence of ART .But further studies are needed to explore various other factors related to adherence in children.


Antiretroviral therapy, Adherence, Paediatric HIV patients

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UNAIDS 2013 global report: UNAIDS report on the global AIDS epidemic, 2013. Available at: Accessed on 10 November 2013.

Chesney MA. Factors Affecting Adherence to Antiretroviral Therapy. Clin Infect Dis. 2000;3(2):171-6.

Rosen S, Fox MP, Gill CJ. Patient retention in antiretroviral therapy programs in Sub -Saharan Africa: A systematic review. PLoS Med. 2007;4(10):298.

Wang X, Yang L, Li H, Zuo L, Liang S, Liu W, et al. Factors associated with HIV virologic failure among patients on HAART for one year at three sentinel surveillance sites in China. Curr HIV Res. 2011;92:103-11.

El-Khatib Z, Katzenstein D, Marrone G, Laher F, Mohapi L, Petzold M, et al. Adherence to drug-refill is a useful early warning indicator of virologic and immunologic failure among HIV patients on first-line ART in South Africa. PLoS One. 2011;6:e17518.

Akahara C, Nwolisa E, Odinaka K, Okolo S. Assessment of Antiretroviral Treatment Adherence among Children Attending Care at a Tertiary Hospital in Southeastern Nigeria. J Tropical Med. 2017;2017:1-4.

Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, et al. Prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med. 2002;17:756-65.

Kuppuswamy B. Manual of Socioeconomic Status (Urban). 1st ed. Delhi: Manasayan; 1981: 66–72.

World Health Organization. WHO Case Definitions of HIV for Surveillance and Revised Clinical Staging and Immunological Classification of HIV-Related Disease in Adults and Children; 2007.

National AIDS Control Organization (2007) Antiretroviral therapy guidelines for HIV-infected adults and adolescents including post-exposure prophylaxis, New Delhi: Ministry of Health & Family Welfare, Government of India. Available: Accessed 20 Dec 2013.

Reddington C, Cohen J, Buldillo A, Toye M, Smith D, Hsu HW. Adherence to medication regimen Among children with Human immunodeficiency virus. Paed Infect Dis. 2000:19:1148-53.

Ekstrand ML CS, Heylen E, Steward W, Singh G. Developing useful highly active antiretroviral therapy adherence measures for India: the Prerana study. J Acquir Immune Defic Syndr. 2010;53(3):415-6.

Luszczynska A, Sarkar Y, Knoll N. Received social support, self-efficacy, and finding benefits in disease as predictors of physical functioning and adherence to antiretroviral therapy. Patient Educ Couns. 2007;66(1):37-42.

Sogarwal R, Bachani D. Assessment of ART centres in India: client perspectives. J Indian Med Assoc. 2009;107:276-80.

Gallant JE, Block DS. Adherence to antiretroviral regimens in HIV-infected patients: Results of a survey among physicians and patients. J Int Asso Physicians AIDS Care. 1998;4(5):32-5.

Cauldbeck MB, Connor CO, Connor MB, Saunders JA , Rao B, et al. Adherence to anti- retroviral therapy among HIV patients in Bangalore, India. AIDS Research and Therapy. 2009;6(7):1381-96.

Venkatesh KK, Srikrishnan AK, Mayer KH, Kumarasamy N, Sudha Raminani E, Lakshmi Prasad T, et al. Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings. AIDS Patient Care STDS. 2010;24(12):795–803.

Murphy DA, Belzer M, Durako SJ, Sarr M, Wilson CM, Muenz LR. Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus. Arch pediatr Adolesc Med. 2005;159:764-70.

Laniece I, Ciss M, Desclaux A, Mbodj F, Ciss M, Diop K. Adherence to HAART and its principal determinants in a cohort of Senegalese adults. AIDS. 2003;17:103-8.

De Bruin M, Hospers HJ, Van den Borne HW, Kok G, Prins JM. Theory- and Evidence Based Intervention to Improve Adherence to Antiretroviral Therapy Among HIV Infected Patients in The Netherlands: A Pilot Study. AIDS Patient Care & STD’s. 2005;19(6):384-94.

Fong OW HC, Fung LY, Lee FK, Tse WH, Yuen CY, Sin KP, et al. Determinants of adherence to highly active antiretroviral therapy (HAART) in Chinese HIV/AIDS patients. HIV Med. 2003;4(2):133-8.

Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. JAIDS. 2003;34(3):281-8.

Wakibi SN, Ng’ang’a ZW, Mbugua GG. Factor associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya AIDS Research and Therapy. 2011;8:43.

Markos E, Worku A, Davey G. Adherence to ART in PLWHA at Yirgalem Hospital, South Ethopia. Ethopia J Health Dev. 2008;22(2):174-9.

Rakmanina NY, Anker J. Therapeutic drug monitoring of antiretroviral. AIDS Patient Care. 2004;18:7-14.