Disclosure of HIV/AIDS and adherence to haart among HIV infected children

Abstract

Background: Adherence to antiretroviral medications is critically important for the success of therapy in patients treated for HIV infection. Many barriers exist which make adherence to HAART difficult for children and families, for example complex regimens, illiteracy of the caregiver, lack of disclosure e.t.c. Disclosure of HIV status to a child by the caregiver is associated with many fears. Objective: To determine the prevalence of disclosure of HIV status to children on HAART and to measure their adherence to HAART. Method: It was a cross sectional study which was carried out at the Kenyatta National Hospital (KNH) Comprehensive Care Centre (CCC) clinic from 10th March to 15th April 2008. Convenient sampling technique was used to sample 120 child caregivers of HIV infected children aged from 7 ., ears who were then interviewed using a structured questionnaire. ;it - Results: Caregivers of children (mean age 10.7 years) were interviewed. Seventy five percent of the children were reported not having known their HIV/AIDS status. The caregivers' major reasons for not telling the child were worries that the child was too young to understand (71.1 %), child might tell other people leading to discrimination and stigmatization (60%), child would have a low self esteem (34.4%); 22.2% of the caregivers were emotionally/psychologically unprepared to tell the child. Ninety seven percent of caregivers agreed that they would disclose the HIV status to the children at a median age of 12 years (range 9-17) and 71.1% of them said they would like the health care worker to facilitate in the process of disclosure. 17.5% of the children were reported to have been non-adherent in the preceding 24 hours before the interview. 14.2% of them had poor adherence in terms of dosing interval while 5% of them were non-adherent in amount/dose taken or in instructions regarding meals. Five of the children who knew their HIV status were among the 21 children who were reported to be non-adherent in the preceding 24 hours. 40% of all children were reported to have missed some doses in the past with the most common reasons being that they ran short of the ARVs (45.8%), they were away from home (29.2%) and they forgot to give the child the drugs (22.9%). Conclusion: Most caregivers had not disclosed the HIV/AIDS status to their children and they required the help of the health care worker to facilitate in disclosure process. Non-adherence rates were high, chiefly due to incorrect dosing interval. Recommendation: Health care workers (HCW) should educate the child and caregiver on the importance of adherence in terms of dose/amount, dosing interval and instructions regarding meals. The HCW should also encourage caregivers to disclose the diagnosis of HIV to the older children