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205 Challenges to Pediatric Adherence to ART Treatment and Strategies to Improve Adherence Among a Large Cohort of Uganda Children

Marion, Natukunda; Nakato, Rhonah

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 2011 - Volume 56 - Issue - p 87
doi: 10.1097/01.qai.0000397387.51759.f7

ISSUES: Perfect adherence (>95%) to highly active antiretroviral treatment(HAART) is critical to treatment success, yet little is known about adherence rates to HAART and strategies to improve adherence among children in resource – limited settings.

DESCRIPTION: Mama's Club Uganda has 2,800 HIV – positive children.1, 200 of these are on HAART, after a rapid scale-up of HIV care and treatment services during the last year. Statistics show that 90% of patients on HAART for 12-15 months have = 95% adherence rates.

LESSONS LEARNED: To support adherence, PIDC a partner organization Mama's Club works with developed an interdisciplinary strategy and several innovative adherence tools that were rolled out with the scale-up of HAART. All cadres of clinic staff play a critical role in reinforcing and promoting adherence to drugs and refill appointments. An adherence nurse visit, home-based adherence assessment and counseling services.Additional adherence tools developed include pictorial aids and cue cards on the principles of HAART; a patient handout on key guidelines for pediatric HAART administration translated in the local language; a standardized psychosocial pre- HAART assessment form incorporation checklists of “high risk” psychosocial situations, disclosure,and common barriers to adherence; and support groups for adolescents and caretakers. An overview of the above tools will be shared, with an in-depth description of the challenges and successes of adherence in this large, urban pediatric cohort.

RECOMMENDATIONS: Home-based unannounced assessments of adherence are necessary to obtain an accurate picture of true adherence rates among patients on HAART.Adherence support of children and adolescents should involve an interdisciplinary team approach using innovative facility and community-based interventions. Research regarding the effectiveness of these interventions is needed.

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