A Bagenda, L Barlow-Mosha, D Bagenda, R Sakwa, M G Fowler, P M Musoke
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引用次数: 26
Abstract
Background: Major obstacles remain in scaling up paediatric HIV treatment, including limited paediatric anti-retroviral drug options for resource-limited settings, challenges with adherence to liquid formulations and treatment fatigue with lifelong therapy.
Aim: To determine levels of adherence to HAART in HIV-infected children at 12, 24, 36 and 48 weeks of follow-up and to compare adherence levels before and after switching from syrup to fixed-dose combination (FDC)-tablet anti-retroviral formulations.
Methods: HIV-infected children aged between 6 months and 12 years were initiated on anti-retroviral therapy at Makerere University-Johns Hopkins University Care Clinic, Kampala. Good adherence to HAART was defined as taking ≥95% of prescribed medications. Adherence levels were measured using pharmacy refill data, quarterly unannounced home-visit pill counts and caregiver self-reports. Data were analysed using STATA(®) version 10.0.
Results: A total of 129 HIV-infected children were initiated on HAART with 14.7% on syrups and 85.3% on tablet formulations at enrollment. According to caregiver self-reporting, 99.2%, 100%, 100% and 99.2% achieved ≥95% adherence at 12, 24, 36 and 48 weeks, respectively. Using pharmacy refill data, the proportions were 89.9%, 95.4%, 93.8% and 93.0% and for unannounced home visits were 89.8%, 92.4%, 88.9% and 86.2%, respectively. Median adherence to syrup formulations (97%, IQR 93-98) was significantly lower than for tablets (100%, IQR 97-100, p = 0.012, n = 28) using pharmacy refill data. Viral suppression correlated with home visit and pharmacy refill adherence data.
Conclusion: The majority of children initiating HAART had good adherence when estimated by caregiver self-report and pharmacy refill data but lower adherence when measured by home-visit pill counts. Adherence to tablet formulation of HAART was significantly better than syrup formulation. Medication formulation did not significantly affect viral suppression.
背景:在扩大儿科艾滋病毒治疗方面仍然存在主要障碍，包括在资源有限的情况下，儿科抗逆转录病毒药物的选择有限，坚持使用液体制剂的挑战以及终身治疗的治疗疲劳。目的:确定艾滋病毒感染儿童在随访12、24、36和48周时对HAART的依从性水平，并比较从糖浆改为固定剂量组合片剂抗逆转录病毒制剂前后的依从性水平。方法:6个月至12岁的艾滋病毒感染儿童在坎帕拉马凯雷雷大学-约翰霍普金斯大学护理诊所开始抗逆转录病毒治疗。良好的HAART依从性定义为服用≥95%的处方药。依从性水平通过药房补充数据、每季度不事先通知的家访药丸数量和护理人员自我报告来衡量。使用STATA(®)10.0版本分析数据。结果:共有129名艾滋病毒感染儿童开始接受HAART治疗，其中14.7%使用糖浆，85.3%使用片剂。根据护理者自我报告，99.2%、100%、100%和99.2%分别在12、24、36和48周时达到≥95%的依从性。使用药房再填资料，其比例分别为89.9%、95.4%、93.8%和93.0%，未通知的家访分别为89.8%、92.4%、88.9%和86.2%。根据药房补充资料，糖浆制剂的中位依从性(97%，IQR 93-98)显著低于片剂(100%，IQR 97-100, p = 0.012, n = 28)。病毒抑制与家访和药房补充依从性数据相关。结论:大多数开始HAART治疗的儿童在照护者自我报告和药房补充数据中有良好的依从性，但在家访药片数量中有较低的依从性。HAART片剂的依从性明显优于糖浆制剂。药物配方对病毒抑制无显著影响。
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