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Association of Antiretroviral and Clinic Adherence With Orphan Status Among HIV-Infected Children in Western Kenya

Vreeman, Rachel C MD, MS*†¶; Wiehe, Sarah E MD, MPH*†¶; Ayaya, Samwel O MBChB, MMED‡¶; Musick, Beverly S MS§¶; Nyandiko, Winstone M MBChB, MMED‡¶

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 2008 - Volume 49 - Issue 2 - p 163-170
doi: 10.1097/QAI.0b013e318183a996
Clinical Science

Background: Pediatric adherence to antiretroviral therapy (ART) is not well studied in resource-limited settings. Reported ART adherence may be influenced by contextual factors, such as orphan status.

Objectives: The objectives of this study were to describe self- and proxy-reported pediatric ART adherence in a resource-limited population and to investigate associated contextual factors.

Patients and Methods: This was a retrospective study involving pediatric, HIV-infected patients in Western Kenya. We included patients aged 0-14 years, who were on ART and had at least 1 adherence measurement (N = 1516). We performed logistic regression to assess the association between orphan status and odds of imperfect adherence, adjusting for sex, age, clinic site, number of adherence measures, and ART duration, stratified by age and ART duration.

Results: Of the 1516 children, only 33% had both parents living when they started ART. Twenty-one percent had only father dead, 28% had only mother dead, and 18% had both parents dead. Twenty-nine percent reported imperfect ART adherence. The odds of ART nonadherence increase for children with both parents dead. Fifty-seven percent of children had imperfect clinic adherence. There was no significant association between orphan status and imperfect clinic adherence.

Conclusions: The majority of pediatric patients in this resource-limited setting maintained perfect ART adherence, though only half kept all scheduled clinic appointments. Understanding contextual factors, such as orphan status, will strengthen adherence interventions.

From the *Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN; †The Regenstrief Institute, Inc, Indianapolis, IN; ‡Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya; §Division of Biostatistics, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN; ¶United States Agency for International Development-Academic Model for the Prevention and Treatment of HIV/AIDS Partnership, Eldoret, Kenya.

Received for publication January 9, 2008; accepted May 16, 2008.

Correspondence to: Rachel C. Vreeman, MD, Children's Health Services Research, Health Information and Translational Sciences Building, Room 1020, West 10th Street, Indianapolis, IN 46202 (e-mail:

Disclaimer: The views expressed in this article are those of the authors and do not necessarily represent the view of the Indiana University School of Medicine and the Moi University School of Medicine. The authors have no conflicts of interest to disclose. R.C.V. had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

© 2008 Lippincott Williams & Wilkins, Inc.