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Abstract
Orphan status and pediatric anti-retroviral therapy adherence in a resource-poor setting
Wiehe S.E.1, Vreeman R.C.1, Musick B.S.2, Yiannoutsos C.T.2, Nyandiko W.M.3
Objective: Assess whether mother’s and/or father’s death is associated with pediatric ART adherence and whether this varies by ART duration.
Methods: Retrospective study of the AMPATH clinical care system. We included patients seen 6/2003-9/2006, 6 months-14 years old, and HIV-infected on ART with at least one adherence measurement (N=989). The adherence measure derived from self-/proxy-reported answer to the question: ‘During the last 7 days, how many doses of his/her antiretroviral medicines did the patient take?’. Imperfect adherence included patients who had at least 1 visit with reported adherence as ‘none’, ‘few’, ‘half’, ‘most’, compared to all visits with ‘all’ reported. Orphan status was defined as neither parent dead (referent), father dead only, mother dead only, or both parents dead. We performed logistic regression with robust standard errors to assess the association between orphan status and odds of imperfect adherence, adjusting for sex, age, school status, tribe and urban clinic site, with an interaction term between orphan status and ART duration (<6/6+ months).
Results: One third of children had neither parent dead, 22% with only father dead, 28% with only mother dead, and 17% with both dead. 26% of children had at least one imperfect adherence measure. Among patients on ART for <6 months, both parents dead was associated with increased odds of imperfect adherence (1.98; 95%CI 1.00,3.91), whereas father dead only (1.02; 95%CI 0.53,1.95) and mother dead only (1.52; 95%CI 0.80,2.87) were not. Among patients on ART for 6+ months, orphan status was not significantly associated with adherence.
Conclusions: Orphan status is a prevalent and complex problem for children with HIV, particularly in resource-poor settings. This analysis suggests that orphan status may influence a child’s ART adherence, primarily immediately following ART initiation. A lack of correlation in later stages may reflect the heterogeneity of social situations following orphanhood in which adherence may vary widely.
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention
Abstract no.
WEPEB095
Suggested Citation
"WieheS.E., et al.
Orphan status and pediatric anti-retroviral therapy adherence in a resource-poor setting.
Poster exhibition:
4th IAS Conference on HIV Pathogenesis, Treatment and Prevention:
Abstract no.
WEPEB095"
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