Predictors of non-adherence to antiretroviral therapy among Hiv-infected children below 10 years attending level 4 and 5 health facilities in Turkana county, Kenya

Abstract

The use of more effective antiretroviral therapy (ART) has significantly improved survival of children infected with Human Immunodeficiency Virus (HIV). However, the benefits of these treatments are limited by non-adherence to the antiretrovirals among pediatrics, particularly in resource-limited settings. In Kenya viral suppression among HIV positive children on ART remains low at 67.1%compared to 90.6% in adults (KENPHIA Report, 2019). In Turkana County,20% of the 1887 children on ART are virally suppressed (Kenya County Profiles Report, 2016). This study sought to determine the predictors of non-adherence to antiretroviral therapy among children below 10 years receiving HIV care and treatment at level 4 and 5 health facilities in Turkana County, Kenya. The study determined: the prevalence of ART non-adherence among HIV-infected children on care; formulation and regimen specific factors associated with ART non-adherence; social-family factors associated with ART non-adherence and health system factors associated with ART non-adherence among HIV infected children. Data was collected through a cross-sectional mixed study design from 173 out of 253 eligible participants attending selected Ministry of Health level 4 and 5 facilities. Data on non-adherence was collected based on Morisky medical scale(rated as 0 being good adherence,1-2 being inadequate adherence, and 3-8 being poor adherence) and hospital medical records whereas data on predictors of non-adherence were collected using semi-structured questionnaires. Key informant interviews and focused group discussions were conducted. Data was analyzed descriptively and summarized using frequencies, means and standard deviations and associations were tested using Pearson’s Chi-square test. Multiple logistic regression analysis was conducted to establish the relationship between the variables (ART formulation and regimen factors; socio-family factors; health care factors) and results summarized using95%confidence interval and odds ratio. Results revealed a cumulative 45.1% (n=78) ART non-adherence prevalence. Whereas the formulation and regimen factors are clinically important, only ART negative side effects variable was statistically significant (χ2 =5.53; p=0.02). However, on regression it did not reach statistical significance. Among socio-family factors, disclosure to other family members (χ2 =6.67; p=0.04; OR=0.185), missed ART days (χ2 =110.90; p=0.01; OR=128.44) and missed ART administration (p=0.02; OR=2.042) by caregivers were shown to have a major effect on ART non-adherence among the children. Through Chi-square test of association all the health care variables assessed were strongly positively related and significant. However, after logistic regression, ART accessibility was statistically significant as the main health care predictor to ART non-adherence among children (χ2 =99.33; p=0.01; OR=1.875). The present study recommends further sensitization of the community to support caregivers in ART administration to children upon caregiver disclosure of the child’s HIV status; sensitization of caregivers on ensuring the child adheres to the ART regimen and not miss intake on any day; county government should take innovative initiatives of ensuring ART accessibility to the caregivers regardless of the distance.