Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala.

BACKGROUND: Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala. AIM: To determine the levels of adherence to HAART and identify factors associated with non-adherence. METHODS: A cross-sectional study of 170 children aged 2-18 years. Adherence to HAART was defined as taking > or =95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2-3 weeks later. RESULTS: The 3-day self-reported > or =95% adherence was 89.4% (n=170). Using clinic-based pill counts, 94.1% (n=170) had > or =95% adherence to treatment compared with only 72% (n=164) by unannounced pill counts. When the primary caregiver was the only one who knew the child's serostatus, he/she was three times more likely to be non-adherent (p=0.02, OR 3.34, 95% CI 1.14-9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have > or =95% adherence (p=0.02, OR 0.44, 95% CI 0.20-0.92). CONCLUSION: The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child's HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.