Determinants of Adherence to Antiretroviral Therapy Among Hiv Positive Children at Kenyatta National Hospital

Abstract

Background: HIV-AIDS is the sixth highest cause of mortality in the world and the leading cause of death in Sub-Saharan Africa. In 2018, there were 1.3 million people living with HIV in Kenya, with an incidence rate of 0.14% adults (15-64 years) annually. The prevalence among adults aged 15-49 years was 4.9%. The prevalence of HIV among children is 0.7% accounting for about 139,000 children aged between 0-14 years. Antiretroviral drugs are currently in use for the management of HIV. In Kenya, HIV remains poorly controlled among children and adolescents (0-18 years) with Viral Load Suppression achieved in only 48.3% of them, which is way below the 90% target which prompts the need to assess common determinants of adherence to antiretroviral therapy. Objective: To examine the extent and determinants of adherence to antiretroviral therapy among HIV positive children receiving treatment at Kenyatta National Hospital. Methods: A hospital-based cross-sectional study was carried out at the KNH Comprehensive Care Centre. Consecutive sampling technique was utilized to recruit 126 HIV positive children. Data was abstracted from patient files using a data abstraction tool, where information on appointment keeping, viral load and adverse events was obtained using a structured questionnaire. Microsoft Excel was used for data entry and then exported to STATA version 13.0. Data analysis included both descriptive and inferential analysis. Categorical data was analyzed using frequencies and percentages and represented in graphs and charts. Continuous data was analyzed using mean (SD) and median (IQR). A binary logistic regression was conducted to determine factors associated with adherence. Adjusted odds ratios were calculated to determine independent factors associated with adherence to ART therapy. Results: Seventy-one (56.3%) of the respondents were female, 44(34.9%) were aged between 15 to 18 years. The duration of disease established that 57(45.2%) had duration of 5 to 10 years while 39(31%) had less than five years of HIV disease. The findings showed that 122(96.8%) were on first line treatment with 91(72.2%) were on CF4E TDF + 3TC + DTG treatment regimen. Four (3.2%) of the respondents were on second line treatment. Adherence to antiretroviral therapy was 112(88.9%), 95%CI: 82.1 – 93.8%. Multivariate analysis showed that being female (AOR = 7.7, 95%CI: 1.07 – 55.93, p=0.043), first line treatment (AOR =2.31, 95%CI: 1.03 – 5.71, p =0.007) and not refusing to take medicines (AOR = 8.11,

95%CI: 3.87 – 20.11, p =0.007) were independent determinants of adherence to antiretroviral therapy. Conclusion: The findings have indicated adherence to be 88.9% which is lower than recommended 95% adherent level. It has also been established that adherence was associated with viral load suppression. Therefore, it is essential to provide a positive social support system that will encourage sharing of responsibility for remembering medication within households if optimum adherence level is to be attained.