Factors Associated with Non-Adherence to Highly Active Antiretroviral Therapy among Children Living with HIV/AIDS from Two Centres in Nigeria - A mixed methods Cross-Sectional Study

BACKGROUND: Highly active antiretroviral therapy (HAART) has changed HIV/AIDS from a deadly disease to chronic disease. This study sought to assess HAART adherence and the factors associated with non-adherence among HIV positive children in two HIV treatment centers.
METHODS: A prospective cross-sectional study using mixed methods was conducted among caregivers of children living with HIV at two HIV treatment centers in Osogbo, Nigeria. Respondents completed interviewer-administered questionnaires on adherence of their children/ward to HAART and the associated factors. In-depth interviews were conducted with selected caregivers that reported non-adherence of their children/ward to HAART. The quantitative data were entered into SPSS version 20 and analyzed using simple and inferential statistics while the qualitative data were analyzed using thematic content analysis.
RESULTS: Sixty-four caregiver-HIV positive children pairs were recruited. Most children were male (64% [95%CI=53.3%-73.3%]); mean age (SD) 6.81 (3.85) years with a range of 1-15 years old. Twelve (19%) had <95% HAART adherence while 16 (25%) ever missed their medication. The factors hindering adherence to HAART include increased age (OR=4.20, 95%CI=1.12-15.87, p=0.034), children from poor homes (OR=3.46, 95%CI=1 .07-11.21, p=0.038), mother not being the primary caregiver (OR=3.86 95%CI=1.18-12.61, p=0.025), caregiver with poor knowledge (OR=3.46, 95%CI=1.07-11.21, p=0.038) and negative attitude (OR=3.67 95%CI=1.13-11.96, p=0.031). In-depth interviews revealed that stigma experience and inappropriate status disclosure affect adherence, especially in older children. Modalities to improve drug adherence included appropriate status disclosure, a reminder to take medication, and ongoing adherence counseling.
CONCLUSION: Identified factors that are responsible for poor drug adherence must be taken into consideration in order to improve adherence for HIV/AIDS medications.