Challenges involved in ART adherence among children

Dec 02, 2010

ABOUT 110,000 children under 15 years are living with HIV/AIDS in Uganda, statistics from Ministry of Health have shown. About 68% of these are in dire need of anti-retroviral therapy (ART), while only 32% are able to access treatment.

Jane Namuddu

ABOUT 110,000 children under 15 years are living with HIV/AIDS in Uganda, statistics from Ministry of Health have shown. About 68% of these are in dire need of anti-retroviral therapy (ART), while only 32% are able to access treatment.

While access to ART remains a challenge for children and adolescents in Uganda, adherence even for those who access treatment is a major stumbling block to HIV prevention and care.
By definition, adherence is the taking of the right dose of ART at the right time and frequency.

The main factors that inhibit adherence include non-disclosure of the children’s HIV status to the children and to the secondary caretakers. It leads to reluctance to take treatment and makes it difficult for caretakers to delegate the responsibility of ensuring that the children take the medication.
It also limits the necessary support that they would have otherwise acquired.

Another factor is poverty, which affects people’s feeding patterns, consistency and access to medication.

Where there is limited food, some parents and caretakers discourage their children from taking multi-vitamins that are sometimes given together with ARVs because they increase their appetite. This speeds up disease progression and increases mortality among people living with HIVAIDS.

Linked to this is the challenge of poor attitudes among parents and children on treatment, limited availability of caretakers and forgetfulness. Some parents and caretakers tend to relegate their role of ensuring that children adhere when they attain a certain age.

While it is true that at a certain age children are able to manage adherence on their own, this should not be taken for granted.
Some children end up giving up and need constant encouragement and reminders.

Unlike children in day schools where parents and caretakers can ensure that they adhere to treatment when they go back home, children in boarding schools are at a greater risk of failing to adhere to treatment. This can be attributed to lack of a supportive environment.

For example, they might not have support from counsellors, peers and pill buddies. Their routine might also not be flexible enough to allow them to take treatment and cope with immediate effects such as dizziness.

To strengthen adherence, parents and caretakers have a major role to play. There is need to sensitise them on the importance of disclosure to children by the age of 10 (HIV Counselling and Testing Policy, 2010). Management of adherence among children should be looked at as a continuous process and not one that should be stopped at a certain age.

There is need to encourage schools to create HIV/AIDS focal persons and equip them with skills to handle children infected and affected by HIV/AIDS.

Schools should also organise peer support activities where experiences can be shared. Pill buddies should also be encouraged where children can remind and support each other to adhere to treatment.

Programmes targeting persons living with HIV/AIDS should also aim at strengthening livelihoods and broadening economic opportunities. Further research is also needed in formulating child-friendly ARVs.

The writer is a Makerere University School of Public Health - CDC HIV/AIDS fellow attached to Baylor - Uganda

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