B16. Adherence to Scheduled appointments and ARV intake among HIV- infected children <13 years at The Lighthouse clinic
R Weigel1, A Nyoni1, J Nyrienda1, E Mhango1, L Thambo1, M Hosseinipour2, S Phiri1 1-Lighthouse centre at Kamuzu Central Hospital (KCH), 2- University of North Carolina Project at KCH
Since assessment of adherence by using pill- count is difficult in children, alternative ways to ensure and measure adherence have to be explored. Children are preferably seen at a weekly clinic at Lighthouse. From their first visit on, HIV- infected children get appointments for subsequent visits. If started on ARV, adherence with ARV intake is assessed by self-report of caregivers by asking for missed doses within the previous 3 days.
Since their first visit appointment keeping was monitored of all children who subsequently started ARV between September 2002 and January 2004. Additionally, with ARV-initiation, self reported ARV intake was documented. Each child was observed for at least 6 months on HAART.
Altogether, 47 children started ARVs during this period. Of those, 5 defaulted, 3 died and 3 stopped treatment. For appointment monitoring, 401 of 451 visits (89%) were available for analysis. 36/47 (76%) children came more than a week late on no more than 2 occasions, counting for 73% of the visits (294/401). Overall, 81% (327/401) of visits either were before the appointment, as scheduled, or within a week thereafter.
For self reported ARV- intake, 363 of 441 visits (82%) were available for analysis. Caregivers of 34/47 (72%) children reported never to have missed a single dose within the previous 3 days before their visits, counting for 264/441 (73%) of visits.
The majority of caregivers and children follow scheduled appointments. Once on ARVs, 72% reported 100% adherence with ARV intake within the previous 3 days before the visit.
Monitoring of appointments and self report by caregivers seem to be a useful alternative to pill counts to assess and reinforce adherence in paediatric HIV care.