Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.4
,
No
.1
, Mar
c
h 201
5,
p
p
.
1
~
6
I
S
SN
: 225
2-8
8
0
6
1
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Factors Affecting Adherence to
Pediatrics Antiretroviral
Therapy in Mekelle Hospital, Tigray Ethiopia
Teklemariam
Gultie
1
, Tes
f
ay G/
Amlak
2
, Girum
Se
bsibie
3
1
Department of Midwifer
y
,
Arb
a
Mi
nch Univ
ersity
, South
e
rn
Ethiopia
2
Department of Pedi
atrics, Axum Hospital, Tigr
ay
Ethiopia
3
Department of Nurs
ing, Addis
Ababa
Un
i
v
ersi
ty,
Eth
i
op
ia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Dec 16, 2014
Rev
i
sed
Jan 24, 201
5
Accepte
d
Fe
b 5, 2015
The m
o
s
t
im
portant fa
ctor in
th
e s
u
cce
ss of HIV treatment is adherence to
antir
etrovir
a
l th
erap
y (ART)
.
T
h
e cha
lleng
e t
o
adheren
ce
t
o
ART is
particular
ly
serious in
Sub-Saharan Africa as th
e high rates of HIV/AIDS
lead
to greater
numbers of affect
ed
individu
als. Although long-
term good
ART adheren
c
e has been obser
ved in ce
rtain s
e
ttings of pub
lic sectors th
e
magnitude of
th
is challenge in
Sub-Sa
haran Afr
i
ca r
e
m
a
ins
l
a
rge
and
ther
e is
eviden
ce for hig
h
rates of patien
t
’s poor
adherence. Stud
y
aimed to assess th
e
factors
affecting
adher
e
nce to p
e
diat
rics an
tiretro
viral
ther
ap
y
(A
RT) among
childr
e
n in
Mekelle hospital,
Tigray
,
Ethiop
ia
.
A
Hospita
l
ba
se
d c
r
oss-
section
a
l stud
y
was conducted on 226 children on antiretrov
i
ral therap
y
f
r
om
Ma
y
01 to 30
/20
14 at Meke
lle h
o
spital
.
Data wa
s colle
cted from
care g
i
vers
of childr
e
n under 15
y
ears old w
ho are on ART.
Of the 226 child
r
en under 15
y
e
ars, 90.3 %
reported complete a
dheren
c
e
to antiretrov
i
r
a
l ther
a
p
y
medications at the regular sched
u
le ove
r
the
pa
st 7 day
s
.
Fa
ctors a
ssoc
i
a
t
ed
with adheren
ce
were having male care
giv
e
r (AOR=2.10[1.01
, 7.22]
), age of
the child (AOR=1.43[1.16
, 3.98
]
)
below 5 y
ear
s and use of fir
s
t line ART
drugs (AOR=2.86[1.54, 3.67]
). Over all th
e adh
e
r
e
nce of ch
ildren
on ART to
their
m
e
dica
tion
in th
is stud
y i
s
rela
tive
l
y hig
h
er as
com
p
are
d
to oth
e
rs
.
However, com
p
let
e
adheren
ce
is
exp
ected in order to make the drugs
effective. Differ
e
nt strate
gies have to be designed
to improve the adheren
c
e
leve
l.
Keyword:
Ad
he
rence
An
tiretrov
i
ral t
h
erap
y
Factors
affecting
Pediatrics
Tigray Et
hiopia
Copyright ©
201
5 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Tek
l
em
aria
m
Gu
ltie,
Depa
rt
m
e
nt
of
M
i
dwi
f
e
r
y
,
Ar
ba M
i
nc
h
U
n
i
v
e
r
si
t
y
,
Ar
ba M
i
nc
h
2
1
,
S
out
her
n
Et
hi
opi
a,
Et
hi
opi
a.
Em
ail: tekledb2002@gm
a
il.com
1.
INTRODUCTION
Gl
o
b
al
l
y
, t
h
er
e
we
re a
b
out
3.
4 m
i
l
l
i
on
HI
V/
AI
DS
i
n
fe
ct
ed
bel
o
w
1
5
y
ears
ol
d c
h
i
l
d
re
n
b
y
t
h
e e
n
d
o
f
2
010
. An
esti
m
a
ted
2
5
0
,
000
ch
ildren
repo
rted
d
e
ad
o
f
AIDS related
co
nd
itio
ns. Maj
o
rity (9
1%) of th
e
HIV infecte
d
lived in Sub-Sa
ha
ra
n Africa.
Howe
ver
only
about 21
% ha
d access to ART and HIV/AIDS
rem
a
i
n
ed o
n
e
of
t
h
e l
e
a
d
i
n
g
causes
o
f
un
de
r fi
ve c
h
ildren m
o
rb
id
ity and m
o
rtalit
y in
su
b-Sah
a
ran Africa
[1]
.
An i
n
de
x case
of H
I
V i
n
Et
hi
o
p
i
a
was re
po
rt
ed i
n
1
9
8
4
. Si
n
ce t
h
en
HI
V/
A
I
D
S
has
becom
e
a
m
a
jor
pu
bl
i
c
h
eal
t
h
conce
r
n of t
h
e c
o
unt
ry
.
C
h
i
l
d
re
n are
p
r
o
f
o
u
ndl
y
af
fe
ct
ed. I
n
2
0
09
an est
i
m
a
t
e
d 72,
94
5
un
de
r
15
y
ear
ol
d
chi
l
d
ren
w
e
re l
i
v
i
n
g
wi
t
h
HI
V.
O
u
t
of
w
h
i
c
h
ab
o
u
t
2
0
,
5
2
2
we
re i
n
ne
ed
of
AR
T
but
onl
y
43%
of t
h
em
got access t
o
t
h
e
r
apy
[2
],
[3
].
An
tiretrov
i
ral
th
erap
y (ART) is a treat
m
e
n
t
for HI
V t
h
at com
b
ines different types of antiretrovi
ral
med
i
catio
n
s
,
wh
ich
sh
ou
ld
b
e
tak
e
n
throug
hou
t life in
ord
e
r to
p
r
ev
ent resistan
ce to
m
e
d
i
catio
n
s
an
d
t
o
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
1 – 6
2
make them
effective. The
drugs ar
e
b
e
co
m
i
n
g
in
creasing
l
y av
ailab
l
e to
ch
ild
ren
in
resou
r
ce-li
m
ited
setti
n
g
s
an
d h
a
v
e
th
e po
ten
tial to
greatly i
m
p
r
o
v
e
the su
rv
i
v
al of
HIV-po
sitiv
e ch
ild
ren
.
Th
e m
o
st im
p
o
r
tan
t
th
ing
for the s
u
ccess
of
HIV treat
ment prog
ram
s
is adhe
rence t
o
antiretrovira
l
treatm
e
nt (ART). HIV treat
ment
adhe
re
nce levels that are
greater t
h
an 95% res
u
lt in
op
ti
m
a
l clin
ical
ou
tco
m
es and
also
en
su
re th
at
i
ndi
vi
dual
s
a
r
e
abl
e
t
o
st
ay
o
n
t
h
ei
r
fi
rst
-
l
i
n
e regi
m
e
ns fo
r
l
o
n
g
er
peri
od
s by
l
i
m
i
t
i
ng t
h
e em
ergence
of
resistan
ce [4
].
Poo
r
ad
h
e
ren
c
es
m
a
y b
e
cau
sed
b
y
fa
ilure
o
f
HAART early in
th
erap
y an
d
will b
ecome a
cause
of drug
resistance late a
f
ter the
r
a
p
y. T
hus
eval
ua
t
i
o
n
of a
d
here
nce i
s
im
port
a
nt
t
o
b
e
abl
e
t
o
m
easure
the efficacy of
antiret
roviral t
h
era
p
y [5].
In
2
0
1
0
,
bel
o
w
15y
rs
ol
d
H
I
V i
n
fect
e
d
c
h
i
l
d
ren
we
re
10
% o
f
al
l
HI
V
i
n
fect
ed
pe
rs
o
n
s,
1
4
%
of
n
e
wly in
fected an
d
1
4
%
o
f
al
l HIV
related
death
s
wo
rl
d
w
i
d
e [6
]. Early in
itiatio
n
and
ad
h
e
ren
ce of ART in
these children
can save their lives. It has
be
en dem
ons
trat
ed
th
at 10
% h
i
g
h
e
r lev
e
l of ad
h
e
ren
ce resu
lts in
2
1
% r
e
du
ctio
n in
d
i
sease
p
r
og
r
e
ssi
on
.
W
ith 95
% adh
e
r
e
nce, v
i
ral supp
ressio
n
to
b
e
low
d
e
tectab
le l
e
v
e
ls
occu
r i
n
80
%,
h
o
we
ve
r a
fal
l
i
n
a
dhe
re
nce
t
o
7
0
%
rapi
dl
y
decrea
ses
vi
ral
su
p
p
res
s
i
o
n
t
o
3
3
%
[7]
.
Ev
e
n
th
ou
gh
t
h
e
r
e are l
i
m
i
t
e
d st
ud
i
e
s on pe
di
at
ri
cs
ART adhe
re
nce in African childre
n
a recent revie
w
report
e
d
th
at ART pro
g
ram
in
Africa
retain
s on
ly 60% o
f
t
h
eir
p
a
tien
t
s after t
w
o
years on
ART
[8]
,
[9]
.
The sa
m
e
st
udi
es re
p
o
rt
e
d
t
h
at
4
0
% t
o
45
% of c
h
i
l
d
re
n ha
d n
o
ad
he
rence t
o
AR
T
[1
0]
. A
not
her
st
udy
su
g
g
est
s
t
h
at
one
q
u
a
r
t
e
r
(2
5
%
)
of
AR
T
use
r
s
do
n
o
t
ac
hi
eve
opt
i
m
al
adh
e
rence
i
n
Af
ri
c
a
[
11]
.
Despi
t
e
o
f
t
h
e
im
port
a
nce
of
adhe
rence t
o
AR
T t
h
e level
of a
dhe
rence
are affecte
d
by differe
nt
fact
or
s. Se
vera
l
st
udi
es i
n
di
c
a
t
e
d t
h
at
t
h
ese
fact
or
s t
h
at fa
vors the a
d
herence of
ART include m
a
le se
x
of
th
e ch
ild
,
du
rat
i
o
n
of
ART m
o
re th
an
28
mo
n
t
h
s
and
the
med
i
an
CD4 co
un
t m
o
re t
h
an
4
40 cells/µl wh
ere
as
m
i
ssing clinic appoi
ntm
e
nt and increasi
ng a
g
e of the
child [12]
faci
litate non adherence
.
In another
stu
d
y
th
e Predicto
rs of poo
r
ad
h
e
re
nce are
m
o
thers as the
pri
m
ary
care gi
ve
r, y
o
u
nge
r than
5 years,
and
prese
n
ce
of c
o
m
o
rbi
d
i
t
y
. Ha
vi
n
g
a m
e
di
cati
on rem
i
nder st
rat
e
gy
, re
g
u
l
a
r
cl
i
n
i
c
vi
si
t
s
and st
at
us
di
scl
o
s
u
re
pre
d
i
c
t
e
d a
bet
t
er ad
here
nce
[
13]
.
I
n
Eth
i
op
ia a stu
d
y
co
ndu
cted
in
H
a
r
a
r
and D
i
r
e
-
D
aw
a sho
w
ed
t
h
at 89
.1% ch
ildr
e
n who
w
e
r
e
on
ART were adhered
to
th
ei
r med
i
catio
n
wh
il
e 8
6
.
9
%
in
Add
i
s Abab
a [14
]
,[1
5
]
. Howev
e
r, litt
le was k
nown
abo
u
t
pe
di
at
ri
cs AR
T m
e
di
cat
i
on ad
here
nce
i
n
Ti
gray
.
This study assess
ed the factors
whic
h affects
the
ad
h
e
ren
ce to ped
i
atrics AR
T
in
Mek
e
le
ho
sp
ital.
2.
R
E
SEARC
H M
ETHOD
Stud
y Are
a
and S
t
ud
y Peri
od
: Th
is st
u
d
y
was cond
u
c
ted
in Mek
e
lle
h
o
s
p
ital wh
ich is fou
n
d
i
n
Ti
gray
re
gi
o
n
a
l
st
at
e, Et
hi
opi
a. The
ho
spi
t
a
l
have
bee
n
gi
v
i
ng se
rvi
ces s
u
ch as H
I
V c
o
u
n
sel
i
n
g an
d t
e
s
t
i
ng,
pr
o
v
i
s
i
on of A
R
T,
t
r
eatm
e
nt
of op
p
o
rt
u
n
i
s
t
i
c
i
n
fect
i
ons
;
p
r
ev
en
tion
of m
o
th
er to
ch
ild
tran
sm
issio
n
,
TB/HIV
con
f
ect
i
o
n t
r
e
a
tm
ent
,
and c
a
re f
o
r
HI
V e
x
p
o
se
d i
n
fant
s
.
The
n
u
m
b
ers of c
h
i
l
d
ren
on
AR
T at
M
e
kel
l
e
h
o
s
p
itals were 4
3
8
an
d
th
e
d
a
ta was co
llected
fro
m
Ma
y 0
1
to
3
0
, 2
0
1
4
. Stud
y d
e
sig
n
:
In
stitu
tio
n b
a
sed
cross
-
sect
i
o
nal
st
u
d
y
was
co
nd
uct
e
d
.
S
o
ur
ce an
d St
u
d
y
Po
pul
at
i
o
n
:
All prim
ary caretak
er
s
of
th
e HIV
infected c
h
ildren we
re the s
o
urce
popu
lation. Careta
kers
of the c
h
ildre
n r
eceiving c
a
re i
n
the
ART clinics of
th
e stud
y facili
ties were con
s
i
d
ered
as th
e
stu
d
y
po
pu
latio
n.
Sample Siz
e
Determination
: The sam
p
le size for t
h
e st
udy
wa
s calculated
u
s
ing
th
e form
u
l
a fo
r
sim
p
l
e
rand
om
sam
p
l
i
ng at
con
f
i
d
e
n
ce i
n
t
e
r
v
al
of 9
5
%
,
an
d de
gree
of p
r
e
c
i
s
i
on 5%
. C
onsi
d
e
r
i
n
g 1
0
%
no
n-
respon
se
rate, t
h
e
fin
a
l sam
p
le size was 226
ch
ild
ren
on
ARTs.
Sa
mpling
a
nd Da
ta
Co
llecti
o
n Procedure
s
:
Acco
rd
ing
to
th
e gu
id
eline o
f
th
e ho
sp
ital all
HIV
p
o
s
itiv
e ind
i
v
i
d
u
a
ls who
u
s
e ART serv
ice
ap
po
in
ted
ev
ery
m
o
n
t
h
.
Th
e
to
tal n
u
m
b
e
r of ch
ild
ren
on
ART
(4
3
8
)
di
vi
ded
by
com
put
ed
s
a
m
p
l
e
si
ze (2
2
6
) t
o
det
e
rm
in
e th
e in
terv
al
between
t
h
e st
ud
y subj
ects.
Th
e f
i
r
s
t
clien
t
was selected
ran
d
o
m
ly
fro
m
th
e list o
f
clien
t
s ap
p
o
i
n
t
ed
for fo
llow-up
in
t
h
e
first d
a
y o
f
d
a
ta co
llection
an
d
2
0
p
a
tien
t
s were appo
in
ted
and
ev
ery o
t
h
e
r
p
a
tien
t
s
caretak
er
were inclu
d
e
d
un
til th
e requ
ired
nu
mb
er
of
study pa
rticipants were ac
hieved.
Struct
ured interviewe
r adm
i
nister
ed quest
i
o
nnai
r
e
was used a
n
d t
h
e
reliab
ility o
f
the in
stru
m
e
n
t
was ch
eck
e
d
usin
g reliab
ility
co
efficien
t wh
ich
was
0
.
8
5
. The co
efficien
t sho
w
ed
g
ood
in
tern
al co
nsisiten
c
y of th
e in
stru
m
e
n
t
. Regu
larly ap
po
in
tm
en
t fo
r
ART fo
llow up
g
i
v
e
n
after o
n
e
m
ont
h an
d t
h
er
e was
n
o
c
h
a
n
c
e
o
f
bei
n
g i
n
t
e
r
v
i
e
we
d t
w
i
ce.
Inclusion
and Exclusion cri
teria
:
C
a
ret
a
k
e
r o
f
chi
l
d
ren
un
de
r t
h
e age
of
15 y
ear
s w
ho
were
o
n
AR
T f
o
r a m
i
nim
u
m
of o
n
e
m
ont
h was i
n
cl
ude
d i
n
t
h
e st
u
d
y
.
T
hose c
h
i
l
d
re
n w
h
o we
re
on
AR
T f
o
r l
e
ss t
h
a
n
one
m
ont
h, t
h
o
s
e H
I
V
i
n
f
ect
ed c
h
i
l
d
re
n
wh
o d
i
dn’
t star
t
ART w
e
r
e
ex
clud
ed.
Da
ta
Pr
ocessi
ng
an
d A
n
al
y
s
i
s
: Data was en
tered
in
t
o
SPSS
v
e
rsi
o
n 16
wind
ows. Th
e
en
tered
d
a
ta
was clean
ed
first an
d
an
alyzed
. Bin
a
ry logistic reg
r
ess was u
s
ed
to
id
en
tify th
e sig
n
i
fican
t d
e
term
in
an
ts of
dos
e a
dhe
rence
.
Fi
nal
l
y
, m
u
l
t
i
vari
at
e a
n
al
y
s
i
s
was
use
d
t
o
i
d
ent
i
f
y
t
h
e m
o
st
im
port
a
nt
de
t
e
rm
i
n
ant
s
.
Ethical Consi
d
erations
: After th
oroug
h
rev
i
sion
o
f
th
e resear
ch ethical approval was
obtained
from
th
e In
stitu
tio
n
a
l Research
bo
ard
of Me
k
e
lle
Un
i
v
ersity Co
l
l
eg
e of
Health
Scien
ces. Letter of coo
p
e
ration
was
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S
I
S
SN
:
225
2-8
8
0
6
Factor
s Affecting A
dhere
nce t
o
Pe
diatrics
A
n
tiret
roviral
Ther
apy
in Mek
elle .... (Tekle
m
ari
a
m Gultie)
3
written for Me
kelle hospital. Oral conse
n
t was obtaine
d
from
each care give
rs be
fore the interview a
nd the
d
a
ta was co
llected
anon
ym
o
u
s
ly to
m
a
in
tain
co
nfid
en
tiality
o
f
th
e clien
t
s.
3.
RESULTS
A
N
D
DI
SC
US
S
I
ON
3.
1.
S
o
ci
o
-
de
mo
gra
phic charac
ters
tics
Th
e st
u
d
y
w
a
s
co
ndu
cted on
a to
tal of
2
26 child
r
e
n on
A
R
T
an
d th
e r
e
spo
n
se r
a
te
w
a
s
100
%. N
e
ar
ly
equal
p
r
o
p
o
rt
i
ons
of m
a
l
e
(5
0.
4%)
an
d
fem
a
l
e
(4
9.
6%
) s
u
bject
s
we
re i
n
vol
ved
i
n
t
h
e s
t
udy
. M
a
j
o
ri
t
y
(
88%
)
were a
b
ove the age of five y
ears.
Howe
ver, their age
r
a
n
g
e
d f
r
om
seven
m
ont
hs t
o
f
o
u
r
t
een y
ears pl
us
t
w
o
m
onths and the
m
e
dian age was at 8.665 years. The
repo
rted
len
g
t
h
of ti
m
e
th
e ch
ild
ren
stayed
on ART
ran
g
e
d
fr
om
one t
o
9
3
m
ont
hs an
d t
h
e m
e
di
an wa
s 4
7
m
ont
hs. F
u
rt
herm
ore, m
a
jo
ri
t
y
(82.
7%
) o
f
t
h
e
ch
ild
ren
’
s care tak
e
rs were
males. Ag
e
o
f
t
h
e ca
re
gi
ver
ran
g
es
f
r
om
19
t
o
8
4
y
ears
an
d t
h
ose
w
h
o
wer
e
urba
n and
rura
l dwellers accounte
d
fo
r 79.2% and 20.8% respectively. Thos
e who we
re
illiterates acc
ounte
d
for
39.4% (
T
able 1)
.
Table
1.
Ge
neral characte
r
istics of the
prim
a
r
y care
give
rs a
n
d their childre
n
Characteristics
Nu
m
b
e
r
(%)
Age of
care giver
<34 y
ear
s
106(
46.
9)
>35 y
ear
s
120(
53.
1)
Sex of car
e giver
Male
39(
17.
3)
Fe
m
a
le
187(
82.
7)
Car
e
giver
s
education
Illiterat
e
89(
39.
4)
Pri
m
a
r
y
93(
41.
2)
Secondar
y
and above
44(
19.
5)
Residence of
care t
a
ker
Ur
ban
179 (
79.
2)
Rural
47(
20.
8)
Age of
the child
< 5 ye
ars
27(
11.
9)
5-
9 y
ear
s
99(
43.
8)
10-
14 y
ear
s
100(
44.
2
Sex of the child
Male
114(
50.
4)
Fe
m
a
le
112(
49.
6)
Dur
a
tion of ART
use
< 36
m
onths
69(
30.
5)
37-
59 m
onths
89(
39.
4)
>60 m
onths
68(
30.
1)
3.2.
Adherence to
An
tire
tr
ovir
a
l therapy
A to
tal
o
f
173
(76
.
5
%
) ch
ild
ren
o
n
ART in th
e st
u
d
y
area
were tak
i
ng
t
h
eir m
e
d
i
catio
n
with
th
e
h
e
lp
of t
h
ei
r ca
re t
a
kers
, b
u
t
t
h
e rest
53 (
2
3
.
5%
)
were t
a
ki
ng
th
eir m
e
d
i
catio
n
b
y
th
em
selv
es. All, (100
%), were
t
a
ki
ng t
h
ei
r m
e
di
cat
i
on t
w
i
c
e per
day
an
d
had
fi
xe
d t
i
m
e t
o
t
a
ke AR
T
.
In
fo
rm
ant
s
of
20
5 (
9
0.
7%) c
h
i
l
d
re
n
rep
o
rt
e
d
t
h
at
t
h
ere
was
no
m
i
ssed do
se by
t
h
e
c
h
i
l
d
re
n sev
e
n day
s
pri
o
r d
a
t
a
col
l
ect
i
on.
B
u
t
m
i
ssed
do
se
w
a
s
rep
o
rt
e
d
by
2
1
(
9
.
3
%)
care
gi
vers
wi
t
h
i
n
t
h
e
l
a
st
seve
n
d
a
ys
and
16
(7
.1%) with
in
t
h
e last
3
d
a
ys. All
th
ese
ch
ild
ren
were t
a
k
i
ng
less t
h
an
95%
of their norm
al dose.
The n
u
m
b
ers
of m
i
ssed dos
es ran
g
e f
r
om
1-
4 wi
t
h
a
m
ean and S
D
of 2
.
3
3
a
n
d
0.9
d
o
ses
resp
ectiv
ely. Th
e h
i
g
h
e
st leng
th
o
f
tim
e
th
e ch
ild
ren
m
i
ss
ed
th
eir sch
e
du
le rang
e fro
m 1
2
to
7
2
ho
urs with
a
med
i
an
of
12
ho
ur
s.
3.
3.
Re
as
on
f
o
r n
o
n
a
dhere
nce
Dru
g
si
d
e
effects, ch
ild
illn
ess, an
d
care taker b
e
ing
bu
sy were th
e m
o
st
co
mm
o
n
reason
s m
e
n
tio
n
e
d
by
2
3
.
8
%
,
23
.
8
%,
an
d
1
4
.
3
% o
f
ca
re
gi
v
e
rs
of
t
h
e c
h
i
l
dre
n
wh
o
we
re m
i
ssed t
h
ei
r
dose
s
re
spec
t
i
v
el
y
(Table 2
)
.
Tabl
e
2. R
eas
o
n
fo
r
no
n a
d
her
e
nce am
ong
p
e
di
at
ri
c AR
T
pa
t
i
e
nt
Reasons for
non a
dher
e
nce
Nu
m
b
e
r
(%)
Child refusal
3(
14.
3)
Busy of
caretaker
3(
14.
3)
Forgetf
u
lness
2(
9.
5)
T
a
ste of the dr
ug
1(
4.
8)
Lack of
trust on the ef
f
i
cacy of
the dr
ug
2(
9.
5)
Illness of the child
5(
23.
8)
Side effect of the d
r
ug
5(
23.
8)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S
V
o
l
.
4,
No
. 1,
M
a
rc
h 20
1
5
:
1 – 6
4
3.
4.
F
a
ct
ors
a
ssoci
a
t
ed
w
i
th
an
ti
retr
ovi
r
a
l
ther
ap
y
adh
e
rence
The pe
rcent
a
g
e
of m
a
l
e
chi
l
dre
n
(
5
0
.
2
%
)
wh
o we
re n
o
t
m
i
ssed t
h
ei
r dos
e sche
dul
e
were al
m
o
st
sim
i
l
a
r t
o
t
h
e fem
a
l
e
chi
l
d
ren
(4
9.
8%)
.
C
h
i
l
dre
n
wi
t
h
i
n
ag
e cat
ego
r
y
of
1
0
-
1
4y
rs,
47
.6
%, an
d 5
-
9y
rs,
42
.9
%
,
were t
h
e m
a
j
o
rities o
f
th
e ind
i
v
i
du
als who
were m
i
sse
d
th
eir
do
se. Tho
s
e
ch
ild
ren
who
h
a
v
e
b
e
en
o
n
AR
T
for
37
-
60 m
ont
hs
(4
0%
) were a
d
here
nt
t
o
t
h
ei
r
m
e
di
cat
i
on.
A
r
o
und
53
.4
% w
e
r
e
no
t
m
i
s
s
ed
th
eir
do
se
w
ith
in
seve
n
day
s
p
r
i
o
r
t
o
dat
a
c
o
l
l
ect
i
on.
Fro
m
th
e to
tal 2
0
5
ch
ild
ren
wh
o
were no
t m
i
ssed
th
ei
r
m
e
dication, 95.1%, were disclose
d
their
HIV
st
at
us t
o
peo
p
l
e
ot
her t
h
a
n
t
h
e care t
a
ker. M
a
jo
ri
t
y
, 90
.5%
,
of i
ndi
vi
d
u
al
s wh
o we
re ad
he
rent
t
o
t
h
ei
r t
h
erapy
w
e
r
e
no
t
g
e
t an
y suppo
r
t
f
r
om
an
y sid
e
. Mo
r
e
th
an
h
a
lf
,
6
6
.6%,
o
f
th
e
ch
ild
r
e
n
wh
o
w
e
r
e
adh
e
r
e
n
t
to
th
eir
t
h
era
p
y
ha
d m
ont
hl
y
f
o
l
l
o
w
up
ap
p
o
i
n
t
m
ent
s
.
C
h
i
l
d
re
n wi
t
h
fem
a
l
e
care t
a
ker a
nd chi
l
dr
en wi
t
h
care t
a
ker
of 3
4
y
r
s
and
bel
o
w wer
e
84.
4% an
d
47.3% of
t
h
e 205
c
h
ildren who we
re
taki
ng their treat
ment according the
rec
o
mmendation gi
ven by their
heal
t
h
pr
ovi
de
rs res
p
ect
i
v
el
y
.
M
o
re
t
h
a
n
t
w
o t
h
i
r
d,
7
9
%
,
o
f
care
t
a
ker
s
of
t
h
e
wel
l
adhe
ri
n
g
c
h
i
l
d
r
e
n w
e
re
l
i
v
i
ng
i
n
ur
ba
n area.
Vari
ous factors
associated with
pediatrics
ART adhe
renc
e are ide
n
t
i
f
i
e
d usi
n
g bi
vari
at
e anal
y
s
i
s
t
echni
q
u
es
. I
n
t
h
e bi
vari
at
e a
n
al
y
s
i
s
;
sex
of
care gi
ver
,
ed
u
cat
i
on
of ca
re
gi
ve
r, a
g
e
of t
h
e c
h
i
l
d
, a
n
d
t
y
pes o
f
AR
T d
r
ug
wer
e
si
gni
fi
ca
nt
l
y
associ
at
ed
wi
t
h
ad
he
rence
o
f
pedi
at
ri
c
AR
T
.
Ha
vi
n
g
m
a
l
e
sex
gi
ver
s
(
O
R
=
2.
70
,
95
% CI (1
.4
5,
9.
63
))
were m
o
re likely
to ad
here to
AR
T than
ch
ildren
with
fem
a
le care
g
i
v
e
r. Tho
s
e ch
ild
ren
who
h
a
d
illiterate (OR=2
.
1
5
, 95
CI (1
.82
,
1
5
.45)) care
g
i
v
e
r were m
o
re lik
ely to
ad
h
e
re to th
eir treat
m
en
t
th
an
t
h
eir coun
ter
p
a
rts.
Age of th
e ch
ildren
h
a
s si
g
n
i
fican
t asso
ciatio
n with
adh
e
rence to
th
ei
r treat
m
en
t.
Th
ose chi
l
dre
n
bel
o
w fi
ve y
ears ol
d (
O
R
=
1
.
23
, 9
5
% C
I
(
1
.
1
4
,
9
.
3
6
))
were
m
o
re l
i
k
el
y
t
o
adhe
re t
o
AR
T t
h
a
n
abo
v
e t
h
e a
g
e
of
fi
ve y
ears
.
Part
i
c
i
p
ant
s
w
ho i
s
o
n
fi
rst
l
i
ne AR
T
(OR
=
2.
51
, 9
5
% C
I
(2
.1
7,
6.
5
2
)
)
i
s
m
o
re
adhe
re
nt
t
h
a
n
t
hos
e
on
t
h
e sec
o
n
d
l
i
n
e
AR
T
dr
u
g
.
All inde
pende
n
t varia
b
les which s
h
owe
d
a
significa
nt association
with place
of delive
r
y care in the
b
i
v
a
riate an
aly
s
is were
p
u
t
i
n
a m
u
ltip
le lo
gistic reg
r
ession m
o
d
e
l. The
dep
e
nd
en
t
v
a
riab
le wh
ich
h
a
s
b
een
u
s
ed
in
th
e
b
i
v
a
riate an
alysi
s
is also
in
clud
ed
i
n
th
e m
u
ltip
le lo
g
i
stic reg
r
ession
an
al
ysis. Th
is v
a
ri
ab
le is
cl
assi
fi
ed as
di
chot
om
ous re
s
p
o
n
se
va
ri
abl
e
whi
c
h i
s
as
si
g
n
e
d t
h
e
val
u
es
0
an
d
1.
In
m
u
ltiv
ariate an
alysis on
ly th
ree ind
e
p
e
n
d
en
t v
a
riab
les sh
owed
sign
ifican
t asso
ciatio
n with
AR
T
adhe
re
nce. T
h
e
s
e variables are;
m
a
le
sex care giver (AOR=
2
.10, 95% CI (1
.0
1, 7
.
22
))
, age o
f
th
e ch
ild
belo
w
fi
ve y
ears
ol
d
(A
OR
=1
.4
3,
9
5
%C
I
(1
.1
6,
3.
98
)) a
n
d use
o
f
fi
rst
l
i
n
e AR
T dr
u
g
(
AOR
=2.
8
6
,
9
5
%C
I
(1
.5
4,
3.
67
))
. E
d
ucat
i
o
n
o
f
t
h
e ca
re
gi
ve
r
whi
c
h s
h
owe
d
a
ssoci
at
i
o
n in
bi
variate
analysis di
dn’t show ass
o
ciation in
th
e m
u
ltiv
ariat
e
an
alysis after con
t
ro
llin
g
fo
r con
f
ou
nd
ers (Tab
le
3
)
.
Tabl
e
3.
Pre
d
i
c
t
o
rs
o
f
a
dhe
ren
ce o
f
pedi
at
ri
cs
AR
T i
n
M
e
kel
l
e
ho
spi
t
a
l
Characteristics
Adher
e
nce
95% CI
(
C
OR)
95% CI
(
AOR
)
Adher
e
nt
Non adher
e
nt
Sex of
caregiver
Male
173 (
84.
4)
14 (
66.
7)
2.
70(
1.
45,
9.
63)
2.
10(
1.
01,
7.
22)
*
Fe
m
a
le
32 (
15.
6)
7 (
33.
3)
1
1
Age of
caregiver
< 34 y
e
ar
s
97(
47.
3)
9(
42.
9)
1.
19(
0.
85,
11.
7
4
)
1.
11 (
0
.
33,
2.
06)
>35 y
ear
s
108(
52.
7)
12(
57.
1)
1
1
E
ducation of
caregiver
Illiterat
e
84(
41)
5(
23.
8)
2.
15(
1.
82,
15.
4
5
)
2.
32(
0.
12,
5.
69)
Pri
m
a
r
y
82(
40)
11(
52.
4)
0.
95(
0.
38,
8.
53)
0.
45(
0.
34,
3.
21)
Secondar
y
39(
19)
5(
23.
8)
1
1
Residence of
caregiver
Ur
ban
162(
79)
17(
81)
0.
88(
0.
37,
0.
94)
0.
43(
0.
36,
0.
99)
Rural
43(
21)
4(
19)
1
1
Sex of the child
Male
103 (
50.
2)
11(
52.
4)
0.
91(
0.
21,
7.
72)
0.
51(
0.
44,
2.
67)
Fe
m
a
le
102 (
49.
8)
10(
47.
6)
1
1
Age of
the child
<5 yea
r
s
25(
12.
2)
2(
9.
5)
1.
23(
1.
14,
9.
36)
1.
43(
1.
16,
3.
98)
*
5 -
9
y
e
ar
s
89(
43.
4)
10(
47.
6)
0.
88(
0.
21,
8.
43)
0.
64(
0.
44,
2.
92)
>10 y
ear
s
91(
44.
4)
9(
42.
9)
1
1
Dur
a
tion of ART
use
<36 m
onths
62(
30.
2)
7(
33.
3)
1.
01(
0.
94,
6.
71)
1.
91(
0.
32,
2.
97)
37-
59 m
onths
82(
40)
7(
33.
3)
1.
34(
1.
21,
7.
43)
1.
56(
0.
24,
2.
23)
>60 m
onths
61(
29.
8)
7(
33.
3)
1
1
T
y
pe of ART dr
ug
First line
201(
98)
20 (
99.
5)
2.
51(
2.
17,
6.
52)
2.
86(
1.
54,
3.
67)
*
Second line
4(
2)
1(
0.
5)
1
1
Disclosure
Yes
195(
95.
1)
20(
95.
2)
0.
97(
0.
73,
15.
2
3
)
0.
83(
0.
12,
8.
43)
No
10(
4.
9)
1(
4.
8)
1
1
Presence of
co
m
o
rbidity
Yes
178(
86.
8)
20(
95.
2)
0.
32(
0.
18,
2.
31)
0.
12(
0.
04,
0.
57)
No
27(
13.
2)
1(
4.
8)
1
1
*si
g
ni
fi
cant
at
P<0.
0
5
, C
I
= C
o
n
f
i
d
e
n
ce i
n
t
e
r
v
al
, C
O
R
=
C
r
u
d
e
od
ds
rat
i
o
,
AOR
=
A
d
j
u
st
e
d
ods
s rat
i
o
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S
I
S
SN
:
225
2-8
8
0
6
Factor
s Affecting A
dhere
nce t
o
Pe
diatrics
A
n
tiret
roviral
Ther
apy
in Mek
elle .... (Tekle
m
ari
a
m Gultie)
5
DIS
C
USSI
ON
It is widely ac
cepted t
h
at adhere
nce to the
r
apy is
cr
uci
a
l
t
o
s
u
ccessf
ul
o
u
t
c
om
es of
A
R
T pr
o
g
ram
.
Ad
he
rence i
s
essent
i
a
l
fo
r p
l
asm
a
vi
ral
su
pp
ressi
on a
n
d
im
m
unol
ogi
c
a
l
resp
on
ses.
AR
T has al
s
o
been
asso
ciated
with
an
im
p
r
ov
ed q
u
a
lity o
f
life
in
p
e
o
p
l
e infe
cted
with
HIV.
Adh
e
ren
ce t
o
th
erap
y, or th
e
ex
ten
t
t
o
whi
c
h a p
a
t
i
e
nt
'
s
behavi
ors c
o
i
n
ci
de
wi
t
h
m
e
di
cal
advi
ce m
u
t
u
al
l
y
negot
i
a
t
e
d bet
w
ee
n t
h
e heal
t
h
p
r
o
f
ession
al and
th
e p
a
tien
t
, is a un
iv
ersal challen
g
e
with
al
l illn
esses and
i
n
all ag
e gro
ups [1
6
]
,[17
]
In
th
is st
u
d
y
th
e lev
e
l of com
p
le
te ad
h
e
ren
ce was
90
.3
% in
th
e 7
d
a
ys p
r
ior d
a
ta co
llectio
n
and
92
.9
% t
h
ree
da
y
s
bef
o
re.
Thi
s
fi
ndi
ng i
s
hi
g
h
e
r t
h
a
n
t
h
e st
u
d
i
e
s co
nd
uct
e
d
i
n
A
ddi
s
Aba
b
a whi
c
h was
8
6
.
9
%,
and
89
.1% i
n
Di
re
dawa a
nd
Hara
r [1
5]
,[
1
8
]
. The pos
si
bl
e
expl
anat
i
o
ns f
o
r s
u
ch
di
ffe
re
nces are t
h
e t
i
m
e of
this study is relatively recent;
it
is
expected
that with ti
m
e
there will be progre
ssive
im
p
r
ovem
ent of patient
care an
d m
a
nagem
e
nt
sy
st
em
s, an
d
di
ffe
re
n
ce i
n
sam
p
l
e
si
ze whi
c
h i
s
a
bi
t
l
o
we
r i
n
t
h
i
s
st
u
d
y
.
A
s
t
udy
carried
ou
t a
m
o
n
g
HIV-infected
ch
ild
ren
at
ten
d
i
ng
ho
sp
itals in
Nig
e
ria
in
d
i
cates th
at o
u
t
of a to
tal o
f
2
12
childre
n, 183
(86%
)
were
a
dhe
re
nt in t
h
e
three
days
preceding t
h
e interview,
while
29
(14%
)
we
re
not
adhe
re
nt
[
19]
whi
c
h i
s
a
l
o
w
e
r t
h
a
n
i
n
t
h
i
s
st
udy
a
n
d
th
e stu
d
y
in Di
re-Dawa an
d Harar bu
t con
s
isten
t
to
th
e
stu
d
y
in Ad
d
i
s-Ab
ab
a.
Ano
t
her qu
alitativ
e syste
m
at
ic rev
i
ew of
resu
lts fro
m
1
3
stud
ies th
at u
s
ed
careg
i
v
e
r
rep
o
rt
s i
ndi
cat
ed t
h
at
3
4
% t
o
10
0%
of ca
re
gi
ve
rs re
p
o
rt
ed
10
0% a
dhe
re
n
ce, an
d 8
4
% t
o
8
9
%
rep
o
rt
e
d
9
5
%
adhe
re
nce; reports of m
ean
adhe
re
nce according to
care
g
ive
r
s ra
nge
d
from
88.4% t
o
96%. Self-reports
,
whi
c
h
were
us
ed i
n
8 st
udi
es
o
v
eral
l
,
i
n
di
ca
t
e
d t
h
at
2
0
%
t
o
58%
o
f
pat
i
e
nt
s re
p
o
rt
ed
1
0
0
% a
dhe
re
nce,
4
4
%
rep
o
rt
e
d
95
%
adhe
re
nce, a
n
d
5
8
% t
o
70%
rep
o
rt
e
d
90
%
adhe
re
nce;
sel
f
-
r
ep
ort
e
d m
ean a
dhe
re
nce r
a
nge
d
fr
om
93%
t
o
9
7
% [2
0]
.
Diffe
re
nt care
g
ive
r
s related factors t
h
at affect
pe
di
at
ri
cs adhe
re
nce
t
o
AR
V m
e
di
cat
i
ons w
e
re
assessed
.
M
a
l
e
sex care
gi
ve
rs fa
vo
rs a
dhe
rence
w
h
i
c
h i
s
sim
i
l
a
r wi
t
h
the fi
n
d
i
ng i
n
t
h
e U
n
i
t
e
d St
at
es o
f
Am
eri
ca and
Ni
ge
ri
a [
16]
,
[
1
9
]
.
I
n
c
o
nt
rast
t
o
t
h
i
s
st
udy
,
i
n
Zam
b
i
a
fem
a
l
e
pat
i
e
nt
s
wer
e
ad
here
nt
t
h
a
n
m
a
l
e
s
[2
1]
.
Ch
ild
related facto
r
wh
ich
sho
w
ed
si
g
n
i
fican
t asso
ci
atio
n
with
ad
h
e
ren
c
e in
th
is st
u
d
y
were ag
e
of
th
e ch
ild
and
typ
e
s o
f
ART d
r
u
g
s
. Ag
e of th
e ch
ild
less
than fi
ve years is signi
fica
ntly associated with
adhe
re
nce
unl
i
k
e t
o
t
h
i
s
fi
ndi
ng
a st
udy
co
n
duct
e
d i
n
It
aly indicates that
childre
n
ov
er
10 years
of a
g
e we
re
m
o
re lik
ely to
ad
h
e
re t
o
th
ei
r
med
i
catio
n
s
than
b
e
low
1
0
y
r
s
.
T
h
e
po
ssi
bl
e
expl
a
n
at
i
o
n f
o
r
t
h
i
s
vari
at
i
o
n
m
i
ght
b
e
d
u
e
to th
e
reason
th
at ch
ild
ren
b
e
low t
h
e ag
e
of
fiv
e
ye
ars a
r
e
una
ble t
o
decide
by t
h
e
m
se
lves to ta
ke their
dr
u
g
an
d t
h
ey
need t
h
e su
p
p
o
r
t
of t
h
ei
r care
gi
ve
rs. T
h
e car
e gi
ver
s
gi
ve m
o
re em
phasi
s and
rem
i
nd t
h
e t
i
m
e
an
d
d
o
s
e th
e ART drug to
b
e
tak
e
n b
y
t
h
eir
ch
ild
. First line ART dru
g
users are adh
e
rent to
th
ei
r m
e
d
i
catio
n
th
an
second
line dr
ug
u
s
er
s.
4.
CO
NCL
USI
O
N
The st
u
d
y
has
t
r
i
e
d t
o
desc
ri
be t
h
e soci
o d
e
m
ogra
p
hic and clinical character
istics o
f
th
e ch
ild
, t
h
e
l
e
vel
of a
d
her
e
nce an
d c
o
m
m
on reaso
n
s
fo
r n
o
n
ad
he
rence and the
pos
sible fact
ors as
sociated with
adhe
re
nce. T
h
e l
e
vel
of ad
he
rence
was rel
a
t
i
v
el
y
goo
d as
com
p
ared to other studie
s. Variables which were
significa
ntly
associated with adhe
re
nce were
m
a
le
se
x car
e gi
ve
r,
y
o
u
n
g
e
r a
g
e
gr
ou
p
o
f
t
h
e
chi
l
d
l
e
ss
t
h
a
n
fi
ve y
ears a
n
d
fi
rst
l
i
n
e
AR
T dr
u
g
users
.
Thi
s
st
u
d
y
ha
s som
e
l
i
m
i
t
a
ti
ons s
u
c
h
as
r
ecal
l
bi
as an
d
ove
r
estim
a
tion of t
h
e level
of a
dherence a
s
re
ported by ca
re
g
i
vers. Ex
tensiv
e
h
ealth
ed
u
cation
fo
r th
e care
g
i
v
e
r
is n
ecessary on tech
n
i
q
u
e
s
h
o
w to adh
e
re to
th
e dru
g
and
it
s im
p
o
r
tan
ce
fo
r th
e
well b
e
i
n
g of t
h
e ch
ild
.
ACKNOWLE
DGE
M
ENTS
The aut
h
o
r
s ar
e very
grat
ef
ul
t
o
M
e
kel
l
e
Hospi
t
a
l
adm
i
ni
st
rat
i
v
e and m
e
di
cal
pers
on
nel
.
W
e
wo
ul
d
lik
e to
th
ank
th
e schoo
l o
f
pu
b
lic h
ealth, co
lleg
e
of m
e
d
i
cin
e
and
h
ealth
scien
ce, Mek
e
lle Un
i
v
ersit
y
for
pr
o
v
i
d
i
n
g t
e
c
h
ni
cal
an
d
fi
na
n
c
i
a
l
sup
p
o
rt
.
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NC
ES
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BIOGRAP
HI
ES OF
AUTH
ORS
Mr.
Teklemaria
m Gultie
was born in Addis Ab
aba, Shoa in
198
8. I have attended my
primar
y
and secondar
y
school in Dejazimach Wendi
r
a
d school. I g
r
aduated from Addis Ababa
University
, Eth
i
opia with
bachelor of science in
2008 and with
masters’ degree
in Reprod
cutiv
e
health in
2013.
I have been
working as a lectur
er
and
researcher for th
e last six
y
ears
in Arb
a
Minch Universit
y
, E
t
hiopi
a. Sin
ce 2014 in additi
on to lecturing
and research activi
ties I am
working as a p
r
oject coordinator of JHPIEG
O Ethiopia Human resource for
health project
funded b
y
USAID. I h
a
ve publis
hed fiv
e
r
e
sear
ch
articles in
diff
eren
t r
e
putable jo
urnals.
Mr.
Tesfay
G/a
mlak
was born
in Tigray
, Eth
i
o
p
ia in 1986.
I h
a
ve attend
ed my
primar
y
and
secondar
y
scho
ol in Agazi school. I gr
aduate
d from Haramay
a
Univ
ersity
, Ethiop
ia with
bachelor of science in 2008
and
with masters’ de
gree
in pediatr
i
cs and child health in 2013. I
have been working as a head of
disease prev
ention and contro
l o
ffice of
Tigr
ay
Regional Health
Bereau
, Ethiop
ia.
Mr.
Gir
u
m Se
bisibie
was born
in Debre Berhan
, Shoa in
1985. I
have
attended
my
p
r
imar
y
and
secondar
y
schoo
l in Hailemariaam Mamo schoo
l.
I gr
aduated fr
om Addis Ababa University
,
Ethiopia with b
a
chelor of scien
c
e in Nursing in
2005 and with
masters’ degree
in pediatrics an
d
child health in 2
012 from Mekelle University
. I
ha
ve been working as a lecturer
and resear
cher
for the last eight
y
e
ars in
Addis A
b
aba Univ
ersity
,
Eth
i
opia.
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