Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study
Identifieur interne : 001778 ( Main/Merge ); précédent : 001777; suivant : 001779Determinants of antiretroviral adherence among HIV positive children and teenagers in rural Tanzania: a mixed methods study
Auteurs : Daniel Nyogea [Tanzanie, Suisse] ; Sally Mtenga [Tanzanie] ; Lars Henning [Tanzanie, Suisse] ; Fabian C. Franzeck [Tanzanie, Suisse] ; Tracy R. Glass [Suisse] ; Emilio Letang [Tanzanie, Suisse, Espagne] ; Marcel Tanner [Tanzanie, Suisse] ; Eveline Geubbels [Tanzanie]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2015.
Abstract
Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan Africa. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART adherence among children and teenagers in rural Tanzania.
We applied a sequential explanatory mixed method design targeting children and teenagers aged 2–19 years residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining focus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined optimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic regression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored issues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was analysed using thematic content analysis.
Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the average adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the qualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity, being unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and forgetfulness were seen to be barriers for optimal adherence.
The study has highlighted specific challenges in ART adherence faced by children and teenagers. Having a biological parent as a caretaker remains a key determinant of adherence among children and teenagers. To achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system need to be designed.
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DOI: 10.1186/s12879-015-0753-y
PubMed: 25637106
PubMed Central: 4314748
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Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Mtenga, Sally" sort="Mtenga, Sally" uniqKey="Mtenga S" first="Sally" last="Mtenga">Sally Mtenga</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Ifakara Health institute, P.O Box 153, Ifakara, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Ifakara Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation></author><author><name sortKey="Henning, Lars" sort="Henning, Lars" uniqKey="Henning L" first="Lars" last="Henning">Lars Henning</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Ifakara Health institute, P.O Box 153, Ifakara, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Ifakara Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation><affiliation wicri:level="3"><nlm:aff id="Aff4">University Hospital of Zurich, Zürich, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>University Hospital of Zurich, Zürich</wicri:regionArea><placeName><settlement type="city">Zurich</settlement><region nuts="3" type="region">Canton de Zurich</region></placeName></affiliation></author><author><name sortKey="Franzeck, Fabian C" sort="Franzeck, Fabian C" uniqKey="Franzeck F" first="Fabian C" last="Franzeck">Fabian C. Franzeck</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Ifakara Health institute, P.O Box 153, Ifakara, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Ifakara Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Glass, Tracy R" sort="Glass, Tracy R" uniqKey="Glass T" first="Tracy R" last="Glass">Tracy R. Glass</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Letang, Emilio" sort="Letang, Emilio" uniqKey="Letang E" first="Emilio" last="Letang">Emilio Letang</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Ifakara Health institute, P.O Box 153, Ifakara, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Ifakara Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation><affiliation wicri:level="4"><nlm:aff id="Aff3">ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain</nlm:aff><country xml:lang="fr">Espagne</country><wicri:regionArea>ISGlobal, Barcelona Ctr. Int. Health Res. (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona</wicri:regionArea><placeName><settlement type="city">Barcelone</settlement><region nuts="2" type="region">Catalogne</region><settlement type="city">Barcelone</settlement></placeName><orgName type="university">Université de Barcelone</orgName></affiliation></author><author><name sortKey="Tanner, Marcel" sort="Tanner, Marcel" uniqKey="Tanner M" first="Marcel" last="Tanner">Marcel Tanner</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Ifakara Health institute, P.O Box 153, Ifakara, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Ifakara Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation><affiliation wicri:level="1"><nlm:aff id="Aff2">Swiss Tropical and Public Health Institute, Basel, Switzerland</nlm:aff><country xml:lang="fr">Suisse</country><wicri:regionArea>Swiss Tropical and Public Health Institute, Basel</wicri:regionArea><wicri:noRegion>Basel</wicri:noRegion></affiliation></author><author><name sortKey="Geubbels, Eveline" sort="Geubbels, Eveline" uniqKey="Geubbels E" first="Eveline" last="Geubbels">Eveline Geubbels</name><affiliation wicri:level="1"><nlm:aff id="Aff1">Ifakara Health institute, P.O Box 153, Ifakara, Tanzania</nlm:aff><country xml:lang="fr">Tanzanie</country><wicri:regionArea>Ifakara Health institute, P.O Box 153, Ifakara</wicri:regionArea><wicri:noRegion>Ifakara</wicri:noRegion></affiliation></author></analytic><series><title level="j">BMC Infectious Diseases</title><idno type="eISSN">1471-2334</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Around 3.3 million children worldwide are infected with HIV and 90% of them live in sub-Saharan Africa. Our study aimed to estimate adherence levels and find the determinants, facilitators and barriers of ART adherence among children and teenagers in rural Tanzania.</p></sec><sec><title>Methods</title><p>We applied a sequential explanatory mixed method design targeting children and teenagers aged 2–19 years residing in Ifakara. We conducted a quantitative cross sectional study followed by a qualitative study combining focus group discussions (FGDs) and in-depth interviews (IDIs). We used pill count to measure adherence and defined optimal adherence as > =80% of pills being taken. We analysed determinants of poor adherence using logistic regression. We held eight FGDs with adolescent boys and girls on ART and with caretakers. We further explored issues emerging in the FGDs in four in-depth interviews with patients and health workers. Qualitative data was analysed using thematic content analysis.</p></sec><sec><title>Results</title><p>Out of 116 participants available for quantitative analysis, 70% had optimal adherence levels and the average adherence level was 84%. Living with a non-parent caretaker predicted poor adherence status. From the qualitative component, unfavorable school environment, timing of the morning ART dose, treatment longevity, being unaware of HIV status, non-parental (biological) care, preference for traditional medicine (herbs) and forgetfulness were seen to be barriers for optimal adherence.</p></sec><sec><title>Conclusion</title><p>The study has highlighted specific challenges in ART adherence faced by children and teenagers. Having a biological parent as a caretaker remains a key determinant of adherence among children and teenagers. To achieve optimal adherence, strategies targeting the caretakers, the school environment, and the health system need to be designed.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Paintsil, E" uniqKey="Paintsil E">E Paintsil</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Paterson, Dl" uniqKey="Paterson D">DL Paterson</name></author><author><name sortKey="Swindells, S" uniqKey="Swindells S">S Swindells</name></author><author><name sortKey="Mohr, J" uniqKey="Mohr J">J Mohr</name></author><author><name sortKey="Brester, M" uniqKey="Brester M">M Brester</name></author><author><name sortKey="Vergis, En" uniqKey="Vergis E">EN Vergis</name></author><author><name sortKey="Squier, C" uniqKey="Squier C">C Squier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Harries, Ad" 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Boulle</name></author><author><name sortKey="Ford, N" uniqKey="Ford N">N Ford</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cohen, Ms" uniqKey="Cohen M">MS Cohen</name></author><author><name sortKey="Chen, Yq" uniqKey="Chen Y">YQ Chen</name></author><author><name sortKey="Mccauley, M" uniqKey="Mccauley M">M McCauley</name></author><author><name sortKey="Gamble, T" uniqKey="Gamble T">T Gamble</name></author><author><name sortKey="Hosseinipour, Mc" uniqKey="Hosseinipour M">MC Hosseinipour</name></author><author><name sortKey="Kumarasamy, N" uniqKey="Kumarasamy N">N Kumarasamy</name></author></analytic></biblStruct></listBibl></div1></back></TEI></record>Pour manipuler ce document sous Unix (Dilib)
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