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AIDS and Behavior

, Volume 23, Issue 2, pp 475–488 | Cite as

Paediatric ART Adherence in South Africa: A Comprehensive Analysis

  • Sabine L. van ElslandEmail author
  • Remco P. H. Peters
  • Nelis Grobbelaar
  • Patiswa Ketelo
  • Maarten O. Kok
  • Mark F. Cotton
  • A. Marceline van Furth
Original Paper

Abstract

Adherence to antiretroviral therapy (ART) remains a challenge for HIV-infected children. In this cross-sectional study, we used structured interview-administered questionnaires and medical records to measure adherence levels and factors associated with adherence and viral suppression. We included 195 South African children aged 2.1–12.9 on ART. Adherence levels ranged between 20.5% (pill count) and 89.1% (self-report). Boys were less adherent according to self-report, girls were less adherent according to pill count. Caregivers ensured medication was taken when the condition directly affected daily life. Well-functioning families and families with high SES provide a context supportive of adherence. Non-disclosure and difficulties administering medication negatively affected adherence and viral suppression. This study shows challenging levels of adherence impacting directly on viral suppression in a South African paediatric HIV program. Gender roles, non-disclosure and difficulty administering medication may undermine adherence and should be taken into account for clinical guidelines, policy design and inform strategies.

Keywords

Adherence Child Paediatric HIV South Africa 

Notes

Acknowledgements

The authors thank the study participants, the staff at the clinical site, TC Newman Hospital and Anova Health Institute and also Mrs. H. Lesch for her assistance with the data collection.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflict of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Stellenbosch University’s human research ethics committee approved this study (reference number N11/11/329).

Informed Consent

All caregivers provided written informed consent for their and their child’s participation. In addition, all children (≥ 7 years) provided written informed assent for their participation.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Sabine L. van Elsland
    • 1
    • 2
    Email author
  • Remco P. H. Peters
    • 3
  • Nelis Grobbelaar
    • 3
  • Patiswa Ketelo
    • 3
  • Maarten O. Kok
    • 4
  • Mark F. Cotton
    • 5
  • A. Marceline van Furth
    • 1
  1. 1.Department of Paediatric Infectious Diseases and ImmunologyVU University Medical CentreAmsterdamThe Netherlands
  2. 2.Department of Paediatrics and Child HealthTygerberg Children’s Hospital and Stellenbosch UniversityCape TownSouth Africa
  3. 3.Anova Health InstituteJohannesburgSouth Africa
  4. 4.Department of Health Care GovernanceErasmus School of Health Policy and Management at Erasmus University RotterdamRotterdamThe Netherlands
  5. 5.FAM-CRU, Department of Paediatrics and Child HealthStellenbosch University and Tygerberg Children’s HospitalCape TownSouth Africa

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