Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda

A. Bagenda, L. Barlow-Mosha, D. Bagenda, R. Sakwa, Mary Glenn Fowler, P. M. Musoke

Research output: Contribution to journalArticle

Abstract

Background: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric antiretroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy. Aim: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of followup and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations. Methods: HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University-Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ≥95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA® version 10.0. Results: A total of 129 HIV-infected children were initiated on HAART with 14.7% on syrups and 85.3% on tablet formulations at enrollment. According to caregiver self-reporting, 99.2%, 100%, 100% and 99.2% achieved >95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89.9%, 95.4%, 93.8% and 93.0% and for unannounced home visits were 89.8%, 92.4%, 88.9% and 86.2%, respectively. Median adherence to syrup formulations (97%, IQR 93-98) was significantly lower than for tablets (100%, IQR 97-100, p=0.012, n=28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data. Conclusion: The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.

Original languageEnglish (US)
Pages (from-to)235-245
Number of pages11
JournalAnnals of Tropical Paediatrics
Volume31
Issue number3
DOIs
StatePublished - Aug 2011
Externally publishedYes

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Uganda
Highly Active Antiretroviral Therapy
House Calls
Tablets
HIV
Pediatrics
Caregivers
Self Report
Therapeutics
Fatigue
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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Adherence to tablet and liquid formulations of antiretroviral medication for paediatric HIV treatment at an urban clinic in Uganda. / Bagenda, A.; Barlow-Mosha, L.; Bagenda, D.; Sakwa, R.; Fowler, Mary Glenn; Musoke, P. M.

In: Annals of Tropical Paediatrics, Vol. 31, No. 3, 08.2011, p. 235-245.

Research output: Contribution to journalArticle

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abstract = "Background: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric antiretroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy. Aim: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of followup and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations. Methods: HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University-Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ≥95{\%} of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA{\circledR} version 10.0. Results: A total of 129 HIV-infected children were initiated on HAART with 14.7{\%} on syrups and 85.3{\%} on tablet formulations at enrollment. According to caregiver self-reporting, 99.2{\%}, 100{\%}, 100{\%} and 99.2{\%} achieved >95{\%} adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89.9{\%}, 95.4{\%}, 93.8{\%} and 93.0{\%} and for unannounced home visits were 89.8{\%}, 92.4{\%}, 88.9{\%} and 86.2{\%}, respectively. Median adherence to syrup formulations (97{\%}, IQR 93-98) was significantly lower than for tablets (100{\%}, IQR 97-100, p=0.012, n=28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data. Conclusion: The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.",
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