Adherence to Antiretroviral Therapy

1
Measuring Pediatric Adherence to Antiretroviral
Therapy in Western Kenya. Rachel C. Vreeman, MD,
MS Winstone M. Nyandiko, MBChB, MMED Samwel O.
Ayaya, MBChB, MMED Edward A. Liechty, MD David
G. Marrero, PhD Thomas S. Inui, ScM, MD
AMPATH RESEARCH SITES
RESEARCH CONTRIBUTION HIGHLIGHTS
OVERVIEW

• Adherence to Antiretroviral Therapy
• Access to antiretroviral therapy (ART) transforms
  HIV/AIDS management into coordinating care of a
  complex chronic disease
• 90 of the worlds 2.5 million HIV-infected
  children live in resource-limited settings
  unaccustomed to chronic disease management
• Central challenge is to sustain high levels of
  adherence to ART to prevent viral resistance and
  opportunistic infections
• To best sustain and improve adherence, we need to
  know who is adherent and who struggles with
  adherence
• Indiana University Kenya Partnership offers
  ideal laboratory in which to study pediatric
  ART adherence and ART dosing

• Research Objective To identify how to measure
  pediatric adherence to antiretroviral therapy
  (ART) in resource-limited settings (RLS)
• Systematic Review of Pediatric ART Adherence in
  Low- and Middle-Income Countries
• Systematic review to identify and critically
  review all existing pediatric ART adherence
  estimates, adherence measurement techniques, and
  correlates of adherence in RLS
• More than 2/3 of studies from RLS reported gt75
  ART adherence
• However, heterogeneous and unvalidated measures
  used to estimate adherence
• Pediatric Adherence and Correlated Factors Among
  Children in AMPATH
• Study Objective To estimate current status of
  pediatric ART adherence and clinic adherence in
  AMPATH
• Study Design Used multivariable logistic
  regression to assess factors associated with
  increased odds of ART or clinic nonadherence
• Of 1516 children on ART, 71 of AMPATH pediatric
  patients reported perfect ART adherence
• Only 33 of children had both parents alive when
  started ART
• Odds of reporting ART nonadherence increased for
  children with both parents dead (OR1.48 95 CI
  1.04 to 2.10), as well as for children on ART for
  12 months or with 6 adherence measurements
• 57 of children had imperfect clinic adherence
• Qualitative Inquiry into Factors Sustaining
  Pediatric Adherence in Western Kenya
• Study Objective To identify key factors
  contributing to pediatric ART adherence in
  western Kenya
• Study Design Conducted 10 focus group
  discussions and 35 key-informant interviews with
  120 parents and guardians of HIV-infected
  children on ART at four AMPATH urban and rural
  clinic sites
• Assessed experience of having children take ART
  and factors inhibiting or facilitating ART
  adherence

RESOURCES

• Childrens Health Services Research (CHSR)
• Section of the Department of Pediatrics at
  Indiana University School of Medicine (IUSM)
• Focuses on research in underserved pediatric
  populations, health policy research, clinical
  decision analysis, and using information and
  technology to improve childrens healthcare
• Started in 2001 under the direction of Dr.
  Stephen Downs
• In 2002, CHSR awarded 2.5 million from Anne E.
  Dyson Foundation to create a laboratory for
  research and education in community pediatrics
• 9 full-time faculty and over 4 million in grants
  beyond initial funding
• The Regenstrief Institute (RI)
• Informatics and healthcare research organization
  established in 1969 in close affiliation with
  IUSM
• Dedicated to improving health through research
  that enhances the quality and cost-effectiveness
  of health care
• Over 120 staff, including 24 full-time
  investigators and 32 affiliated investigators
• Academic Model for the Prevention and
  Treatment of HIV/AIDS (AMPATH)
• Formed in 2000 as collaboration of IUSM, Moi
  University School of Medicine, Moi Teaching and
  Referral Hospital in Eldoret, Kenya
• AMPATH is the most rapidly expanding, highest
  quality, and cost-effective HIV/AIDS care program
  in sub-Saharan Africa
• Operates 18 sites, employing gt600 clinicians and
  staff
• Have enrolled over 80,000 HIV-infected adults and
  children, with over 55,000 active patients
• 48 of adult patients on combination ART (free
  through AMPATH)
• 13,802 patients are 14 years, with 2,866
  currently on ART
• Designed and implemented sub-Saharan Africas
  first outpatient electronic medical record
  system, which tracks patients for clinical and
  research purposes
• IU-Kenya Partnership and AMPATH have received
  over 106 million in funded grants and contracts
  to date

AMPATH Clinic Sites in Western Kenya. AMPATH
Centre located in Eldoret (1).
Ward 12 of Moi Teaching and Referral Hospital in
Eldoret, Kenya. Setting and Study Personnel for
AMPATH Inpatient Pediatric Pharmacokinetics
Studies.
CONTACT INFORMATION

• Rachel C. Vreeman, MD, MS
• Faculty Scholar, Indiana CTSI
• Assistant Professor of Pediatrics, Childrens
  Health Services Research, Indiana University
  School of Medicine
• Co-Director of Pediatric Research, Indiana
  University Kenya Partnership
• E-mail rvreeman_at_iupui.edu
• Phone [phone]