High risk of ART non-adherence and delay of ART initiation among HIV positive double orphans in Kigali, Rwanda

Kimiyo Kikuchi, Krishna C. Poudel, John Muganda, Adolphe Majyambere, Keiko Otsuka, Tomoko Sato, Vincent Mutabazi, Simon Pierre Nyonsenga, Ribakare Muhayimpundu, Masamine Jimba, Junko Yasuoka

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Abstract

Background: To reduce HIV/AIDS related mortality of children, adherence to antiretroviral treatment (ART) is critical in the treatment of HIV positive children. However, little is known about the association between ART adherence and different orphan status. The aims of this study were to assess the ART adherence and identify whether different orphan status was associated with the child's adherence. Methods: A total of 717 HIV positive children and the same number of caregivers participated in this cross-sectional study. Children's adherence rate was measured using a pill count method and those who took 85% or more of the prescribed doses were defined as adherent. To collect data about adherence related factors, we also interviewed caregivers using a structured questionnaire. Results: Of all children (N = 717), participants from each orphan category (double orphan, maternal orphan, paternal orphan, non-orphan) were 346, 89, 169, and 113, respectively. ART non-adherence rate of each orphan category was 59.3%, 44.9%, 46.7%, and 49.7%, respectively. The multivariate analysis indicated that maternal orphans (AOR 0.31, 95% CI 0.12-0.80), paternal orphans (AOR 0.35, 95% CI 0.14-0.89), and non-orphans (AOR 0.45, 95% CI 0.21-0.99) were less likely to be non-adherent compared to double orphans. Double orphans who had a sibling as a caregiver were more likely to be non-adherent. The first mean CD4 count prior to initiating treatment was 520, 601, 599, and 844 (cells/ml), respectively (p<0.001). Their mean age at sero-status detection was 5.9, 5.3, 4.8, and 3.9 (year old), respectively (p<0.001). Conclusions: Double orphans were at highest risk of ART non-adherence and especially those who had a sibling as a caregiver had high risk. They were also in danger of initiating ART at an older age and at a later stage of HIV/AIDS compared with other orphan categories. Double orphans need more attention to the promote child's adherence to ART.

Original languageEnglish
Article numbere41998
JournalPloS one
Volume7
Issue number7
DOIs
Publication statusPublished - Jul 30 2012

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Rwanda
Orphaned Children
caregivers
HIV
Therapeutics
Caregivers
cross-sectional studies
multivariate analysis
Siblings
Acquired Immunodeficiency Syndrome
questionnaires
Mothers
Child Mortality
CD4 Lymphocyte Count
dosage
Multivariate Analysis
methodology

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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High risk of ART non-adherence and delay of ART initiation among HIV positive double orphans in Kigali, Rwanda. / Kikuchi, Kimiyo; Poudel, Krishna C.; Muganda, John; Majyambere, Adolphe; Otsuka, Keiko; Sato, Tomoko; Mutabazi, Vincent; Nyonsenga, Simon Pierre; Muhayimpundu, Ribakare; Jimba, Masamine; Yasuoka, Junko.

In: PloS one, Vol. 7, No. 7, e41998, 30.07.2012.

Research output: Contribution to journalArticle

Kikuchi, K, Poudel, KC, Muganda, J, Majyambere, A, Otsuka, K, Sato, T, Mutabazi, V, Nyonsenga, SP, Muhayimpundu, R, Jimba, M & Yasuoka, J 2012, 'High risk of ART non-adherence and delay of ART initiation among HIV positive double orphans in Kigali, Rwanda', PloS one, vol. 7, no. 7, e41998. https://doi.org/10.1371/journal.pone.0041998
Kikuchi, Kimiyo ; Poudel, Krishna C. ; Muganda, John ; Majyambere, Adolphe ; Otsuka, Keiko ; Sato, Tomoko ; Mutabazi, Vincent ; Nyonsenga, Simon Pierre ; Muhayimpundu, Ribakare ; Jimba, Masamine ; Yasuoka, Junko. / High risk of ART non-adherence and delay of ART initiation among HIV positive double orphans in Kigali, Rwanda. In: PloS one. 2012 ; Vol. 7, No. 7.
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abstract = "Background: To reduce HIV/AIDS related mortality of children, adherence to antiretroviral treatment (ART) is critical in the treatment of HIV positive children. However, little is known about the association between ART adherence and different orphan status. The aims of this study were to assess the ART adherence and identify whether different orphan status was associated with the child's adherence. Methods: A total of 717 HIV positive children and the same number of caregivers participated in this cross-sectional study. Children's adherence rate was measured using a pill count method and those who took 85{\%} or more of the prescribed doses were defined as adherent. To collect data about adherence related factors, we also interviewed caregivers using a structured questionnaire. Results: Of all children (N = 717), participants from each orphan category (double orphan, maternal orphan, paternal orphan, non-orphan) were 346, 89, 169, and 113, respectively. ART non-adherence rate of each orphan category was 59.3{\%}, 44.9{\%}, 46.7{\%}, and 49.7{\%}, respectively. The multivariate analysis indicated that maternal orphans (AOR 0.31, 95{\%} CI 0.12-0.80), paternal orphans (AOR 0.35, 95{\%} CI 0.14-0.89), and non-orphans (AOR 0.45, 95{\%} CI 0.21-0.99) were less likely to be non-adherent compared to double orphans. Double orphans who had a sibling as a caregiver were more likely to be non-adherent. The first mean CD4 count prior to initiating treatment was 520, 601, 599, and 844 (cells/ml), respectively (p<0.001). Their mean age at sero-status detection was 5.9, 5.3, 4.8, and 3.9 (year old), respectively (p<0.001). Conclusions: Double orphans were at highest risk of ART non-adherence and especially those who had a sibling as a caregiver had high risk. They were also in danger of initiating ART at an older age and at a later stage of HIV/AIDS compared with other orphan categories. Double orphans need more attention to the promote child's adherence to ART.",
author = "Kimiyo Kikuchi and Poudel, {Krishna C.} and John Muganda and Adolphe Majyambere and Keiko Otsuka and Tomoko Sato and Vincent Mutabazi and Nyonsenga, {Simon Pierre} and Ribakare Muhayimpundu and Masamine Jimba and Junko Yasuoka",
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AU - Kikuchi, Kimiyo

AU - Poudel, Krishna C.

AU - Muganda, John

AU - Majyambere, Adolphe

AU - Otsuka, Keiko

AU - Sato, Tomoko

AU - Mutabazi, Vincent

AU - Nyonsenga, Simon Pierre

AU - Muhayimpundu, Ribakare

AU - Jimba, Masamine

AU - Yasuoka, Junko

PY - 2012/7/30

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N2 - Background: To reduce HIV/AIDS related mortality of children, adherence to antiretroviral treatment (ART) is critical in the treatment of HIV positive children. However, little is known about the association between ART adherence and different orphan status. The aims of this study were to assess the ART adherence and identify whether different orphan status was associated with the child's adherence. Methods: A total of 717 HIV positive children and the same number of caregivers participated in this cross-sectional study. Children's adherence rate was measured using a pill count method and those who took 85% or more of the prescribed doses were defined as adherent. To collect data about adherence related factors, we also interviewed caregivers using a structured questionnaire. Results: Of all children (N = 717), participants from each orphan category (double orphan, maternal orphan, paternal orphan, non-orphan) were 346, 89, 169, and 113, respectively. ART non-adherence rate of each orphan category was 59.3%, 44.9%, 46.7%, and 49.7%, respectively. The multivariate analysis indicated that maternal orphans (AOR 0.31, 95% CI 0.12-0.80), paternal orphans (AOR 0.35, 95% CI 0.14-0.89), and non-orphans (AOR 0.45, 95% CI 0.21-0.99) were less likely to be non-adherent compared to double orphans. Double orphans who had a sibling as a caregiver were more likely to be non-adherent. The first mean CD4 count prior to initiating treatment was 520, 601, 599, and 844 (cells/ml), respectively (p<0.001). Their mean age at sero-status detection was 5.9, 5.3, 4.8, and 3.9 (year old), respectively (p<0.001). Conclusions: Double orphans were at highest risk of ART non-adherence and especially those who had a sibling as a caregiver had high risk. They were also in danger of initiating ART at an older age and at a later stage of HIV/AIDS compared with other orphan categories. Double orphans need more attention to the promote child's adherence to ART.

AB - Background: To reduce HIV/AIDS related mortality of children, adherence to antiretroviral treatment (ART) is critical in the treatment of HIV positive children. However, little is known about the association between ART adherence and different orphan status. The aims of this study were to assess the ART adherence and identify whether different orphan status was associated with the child's adherence. Methods: A total of 717 HIV positive children and the same number of caregivers participated in this cross-sectional study. Children's adherence rate was measured using a pill count method and those who took 85% or more of the prescribed doses were defined as adherent. To collect data about adherence related factors, we also interviewed caregivers using a structured questionnaire. Results: Of all children (N = 717), participants from each orphan category (double orphan, maternal orphan, paternal orphan, non-orphan) were 346, 89, 169, and 113, respectively. ART non-adherence rate of each orphan category was 59.3%, 44.9%, 46.7%, and 49.7%, respectively. The multivariate analysis indicated that maternal orphans (AOR 0.31, 95% CI 0.12-0.80), paternal orphans (AOR 0.35, 95% CI 0.14-0.89), and non-orphans (AOR 0.45, 95% CI 0.21-0.99) were less likely to be non-adherent compared to double orphans. Double orphans who had a sibling as a caregiver were more likely to be non-adherent. The first mean CD4 count prior to initiating treatment was 520, 601, 599, and 844 (cells/ml), respectively (p<0.001). Their mean age at sero-status detection was 5.9, 5.3, 4.8, and 3.9 (year old), respectively (p<0.001). Conclusions: Double orphans were at highest risk of ART non-adherence and especially those who had a sibling as a caregiver had high risk. They were also in danger of initiating ART at an older age and at a later stage of HIV/AIDS compared with other orphan categories. Double orphans need more attention to the promote child's adherence to ART.

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