Determinants of adherence to highly active antiretroviral therapy among HIV-infected children in Rwanda.

Introduction: Adherence to antiretroviral therapy (ART) among HIV-infected children is influenced by numerous socio-economic clinical spiritual and psychological factors. Interrupted adherence can result in resistance to first-line ART. In such cases patients may infect others with resistant virus strains and they may require a significantly more expensive second-line ART regimens which are more difficult to procure and more difficult for patients to access. Thus ART adherence influences not only individual and population outcomes but also has significant implications for long-term healthcare financing. It is essential to determine and address the factors that impact a patient’s likelihood to adhere to ART. Objective: This study investigates factors that are associated with HIV-infected children’s adherence to highly active antiretroviral therapy (HAART) in Rwanda. Methods: Five health facilities were visited in August 2005. Each health facility was treating HIV-infected children who had been receiving HAART for at least 12 months. Participants included children under 15 years who were treated with HAART for at least 12 months at the selected health facilities. A standard questionnaire was employed for each caregiver participant and administered in his or her home. Non-adherence was defined as missing at least one dose of ART during a 12 month period of HAART treatment. Results: Among the study participants 59% were girls and 41% were boys. Thirty-four percent of children had missed at least one dose of HAART in the past 12 months; forgetfulness (38%) and change in treatment routine (27%) were the most common reasons for missing doses. Caregivers who were members of an association for people living with HIV or AIDS (PLWHA) were more likely to be adherent than those who were not (p=0.031). The more time it took for children to be served at health centers the less likely they were to be adherent (p=0.043). Finally caregivers who were satisfied with the health care their children were receiving had children who were more likely to be adherent compared to those caregivers who were unsatisfied (p=0.001). Conclusion: In order for Rwanda to increase full pediatric adherence to HAART it must review the national counseling protocol to provide caregivers and children with tools to combat forgetfulness; it must sensitize child caregivers to join associations of PLWHA; and it must promote improved “customer care” practices at health centers.