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What makes orphans in Kigali, Rwanda, non-adherent to antiretroviral therapy? Perspectives of their caregivers.

Kikuchi K, Poudel KC, Muganda J, Sato T, Mutabazi V, Muhayimpundu R, Majyambere A, Nyonsenga SP, Sase E, Jimba M - J Int AIDS Soc (2014)

Bottom Line: The study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans.In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence.Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.

View Article: PubMed Central - PubMed

Affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

ABSTRACT

Introduction: Every year, approximately 260,000 children are infected with HIV in low- and middle-income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV-positive children. We need to develop a better understanding of the background of children's ART non-adherence because it is not well understood. The purpose of this study is to explore the background related to ART non-adherence, specifically in relation to the orphan status of children in Kigali, Rwanda.

Methods: We conducted 19 focus group discussions with a total of 121 caregivers of HIV-positive children in Kigali. The primary data for analysis were verbatim transcripts and socio-demographic data. A content analysis was performed for qualitative data analysis and interpretation.

Results: The study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans' caregivers, and feelings of guilt about the child's condition among non-orphaned caregivers.

Conclusions: Knowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV-positive children. In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.

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Related in: MedlinePlus

Flowchart summarizing participant inclusion and categories.
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Figure 0001: Flowchart summarizing participant inclusion and categories.

Mentions: The 365 potential FGD participants were classified as adherent or non-adherent, based on the results of our survey. Adherence was measured by pill count, which was previously announced. According to the World Health Organization (WHO) guideline for adherence, a child taking less than 85% of the monthly prescribed pills was considered non-adherent, 85% was poor adherence, and an 85% or higher adherence rate was the minimum level to achieve HIV suppression and the clinical benefits of ART [27]. Caregivers were classified into four categories, corresponding to their child's orphan status: double orphan, paternal orphan, maternal orphan and non-orphan. We arranged two FGDs for each of the eight categories (16 FGDs) with two groups each of adherent and non-adherent caregivers composed of a mix of orphan categories (four FGDs). Two FGDs were organized for each category because two was the minimum number of groups needed to obtain different views of the same category's participants [21]. We could form only one FGD for caregivers of adherent maternal orphans due to the lack of eligible participants (Figure 1).


What makes orphans in Kigali, Rwanda, non-adherent to antiretroviral therapy? Perspectives of their caregivers.

Kikuchi K, Poudel KC, Muganda J, Sato T, Mutabazi V, Muhayimpundu R, Majyambere A, Nyonsenga SP, Sase E, Jimba M - J Int AIDS Soc (2014)

Flowchart summarizing participant inclusion and categories.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4256520&req=5

Figure 0001: Flowchart summarizing participant inclusion and categories.
Mentions: The 365 potential FGD participants were classified as adherent or non-adherent, based on the results of our survey. Adherence was measured by pill count, which was previously announced. According to the World Health Organization (WHO) guideline for adherence, a child taking less than 85% of the monthly prescribed pills was considered non-adherent, 85% was poor adherence, and an 85% or higher adherence rate was the minimum level to achieve HIV suppression and the clinical benefits of ART [27]. Caregivers were classified into four categories, corresponding to their child's orphan status: double orphan, paternal orphan, maternal orphan and non-orphan. We arranged two FGDs for each of the eight categories (16 FGDs) with two groups each of adherent and non-adherent caregivers composed of a mix of orphan categories (four FGDs). Two FGDs were organized for each category because two was the minimum number of groups needed to obtain different views of the same category's participants [21]. We could form only one FGD for caregivers of adherent maternal orphans due to the lack of eligible participants (Figure 1).

Bottom Line: The study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans.In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence.Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.

View Article: PubMed Central - PubMed

Affiliation: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

ABSTRACT

Introduction: Every year, approximately 260,000 children are infected with HIV in low- and middle-income countries. The timely initiation and high level of maintenance of antiretroviral therapy (ART) are crucial to reducing the suffering of HIV-positive children. We need to develop a better understanding of the background of children's ART non-adherence because it is not well understood. The purpose of this study is to explore the background related to ART non-adherence, specifically in relation to the orphan status of children in Kigali, Rwanda.

Methods: We conducted 19 focus group discussions with a total of 121 caregivers of HIV-positive children in Kigali. The primary data for analysis were verbatim transcripts and socio-demographic data. A content analysis was performed for qualitative data analysis and interpretation.

Results: The study found several contextual factors that influenced non-adherence: among double orphans, there was psychological distance between the caregivers and children, whereas economic burden was the primary issue among paternal orphans. The factors promoting adherence also were unique to each orphan status, such as the positive attitude about disclosing serostatus to the child by double orphans' caregivers, and feelings of guilt about the child's condition among non-orphaned caregivers.

Conclusions: Knowledge of orphan status is essential to elucidate the factors influencing ART adherence among HIV-positive children. In this qualitative study, we identified the orphan-related contextual factors that influenced ART adherence. Understanding the social context is important in dealing with the challenges to ART adherence among HIV-positive children.

Show MeSH
Related in: MedlinePlus