AIDS and Behavior

, Volume 13, Issue 1, pp 23–32 | Cite as

Correlates of Adherence to Antiretroviral Therapy in HIV-Infected Children in Lomé, Togo, West Africa

  • Julie Polisset
  • Francine Ametonou
  • Elise Arrive
  • Anthony Aho
  • Freddy Perez
Original Paper


We assessed pediatric adherence to antiretroviral therapy (ART) and examined associated factors among children in Togo, West Africa. Structured interviews of caregivers of consecutively enrolled HIV-infected children receiving ART in three HIV/AIDS care centers in Lome, Togo were conducted. Child perfect adherence reflected caregivers’ report of no antiretroviral drug doses missed neither in the past 4 days nor in the month before the interview. A total of 74 ART-treated children were included (median age 6 years). Of these, 42% of caregivers declared perfect adherence. In univariate analyses, the major factors relating to child non-adherence were: being female, living in an individual setting (vs. compound with enlarged family), receiving other ART than an NNRT-based regimen, drug regimens with six pills/spoons or more per day, caregiver other than biological parent, caregiver not declaring HIV-status, not participating to support groups and having perceived difficulty of antiretroviral (ARV) administration. In multivariate analysis, female gender, living in an individual setting, receiving other than NNRTI-based regimen and caregivers’ perceived difficulty of ARV administration remained independently associated with the reported child’s non-adherence. These data show low rates of perfect adherence to ART in children in West Africa, influenced by child and caregiver characteristics and suggest a need for counseling and education interventions as well as continuous psychological and social support.


Adherence Antiretroviral therapy Correlates Children Africa 



The authors would like to acknowledge the French association “Initiative Développement” as well as the staff of the NGOs “Action contre le SIDA”, “Aides Médicales et Charité” and « Espoir Vie Togo”, based in Lome, Togo for their support for this study. We are grateful to the caregivers and children for their participation in the interviews. Comments during the preparation of the manuscript from Isabelle Gobatto, Marthe-Aline Jutand, Anne Tijou-Traoré and Francois Dabis are greatly valued. We also thank two AIDS and Behavior reviewers for their useful comments and suggestions.


  1. Abaia-Barrero, C. E., & Castro, A. (2006). Experiencing of stigma and access to HAART in children and adolescents living with HIV/AIDS in Brazil. Social Science and Medicine, 62, 1219–1228. doi:10.1016/j.socscimed.2005.07.006.CrossRefGoogle Scholar
  2. Altice, F. L., Mostashari, F., & Friedland, G. H. (2001). Trust and the acceptance of and adherence to antiretroviral therapy. Journal Acquired Immune Deficiency Syndrome, 1, 47–58.Google Scholar
  3. Arrivé, E., Anaky, M. F., Wemin, M. L., Diabaté, B., Rouet, F., Salamon, R., et al. (2005). Assessment of adherence to highly active antiretroviral therapy in a cohort of African HIV-infected children in Abidjan, Côte d’Ivoire. Journal Acquired Immune Deficiency Syndrome, 40, 498–500. doi:10.1097/01.qai.0000168180.76405.5f.CrossRefGoogle Scholar
  4. Bikaako-Kajura, W., Luyirika, E., Purcell, D. W., Downing, J., Kaharuza, F., Mermin, J., et al. (2006). Disclosure of HIV status and adherence to daily drug regimens among HIV-infected children in Uganda. AIDS and Behavior, 10, S85–S93. doi:10.1007/s10461-006-9141-3.PubMedCrossRefGoogle Scholar
  5. Boni, S., Pontali, E., De Gol, P., Pedemonte, P., & Bassetti, D. (2000). Compliance to combination antiretroviral therapy in HIV-1 infected children. International Journal of Antimicrobial Agents, 16, 371–372. doi:10.1016/S0924-8579(00)00256-9.PubMedCrossRefGoogle Scholar
  6. Brackis-Cott, E., Mellins, C. A., Abrams, E., Reval, T., & Dolezal, C. (2003). Pediatric HIV medication adherence: The views of medical providers from two primary care programs. Journal of Pediatric Health Care, 5, 252–260. doi:10.1016/S0891-5245(02)88313-4.CrossRefGoogle Scholar
  7. Brigido, L., Rodrigues, R., Casseb, J., Oliveira, D., Rossetti, M., Menezes, P., et al. (2001). Impact of adherence to antiretroviral therapy in HIV-1-infected patients at a university public service in Brazil. AIDS Patient Care and STDs, 11, 587–593. doi:10.1089/108729101753287685.CrossRefGoogle Scholar
  8. Calmy, A., Klement, E., Teck, R., Berman, D., Pécoul, B., & Ferradini, L. (2004). Simplifying and adapting antiretroviral treatment in resource-poor settings: A necessary step to scaling-up. AIDS (London, England), 18, 2353–2360.Google Scholar
  9. Dolezal, C., Mellins, C., Brackis-Cott, E., & Abrams, E. J. (2003). The reliability of reports of medical adherence from children with HIV and their adult caregivers. Journal of Pediatric Psychology, 28, 355–361. doi:10.1093/jpepsy/jsg025.PubMedCrossRefGoogle Scholar
  10. Fassinou, P., Elenga, N., Rouet, F., Laguide, R., Kouakoussui, K. A., Timite, M., et al. (2004). Highly active antiretroviral therapies among HIV-1-infected children in Abidjan, Cote d’Ivoire. AIDS (London, England), 18, 1905–1913. doi:10.1097/00002030-200409240-00006.Google Scholar
  11. George, E., Noel, F., Bois, G., Cassagnol, R., Estavien, L., Rouzier Pde, M., et al. (2007). Antiretroviral therapy for HIV-1-infected children in Haiti. The Journal of Infectious Diseases, 10, 1411–1418. doi:10.1086/514823.CrossRefGoogle Scholar
  12. Giacomet, V., Albano, F., Starace, F., de Franciscis, A., Giaquinto, C., Castelli, G. G., et al. (2003). Adherence to antiretroviral therapy and its determinants in children with human immunodeficiency virus infection: A multicentre, national study. Acta Paediatrica (Oslo, Norway), 92, 1398–1402. doi:10.1080/08035250310006737.CrossRefGoogle Scholar
  13. Gibb, D. M., Duong, T., Tookey, P. A., Sharland, M., Tudor-Williams, G., Novelli, V., et al. (2003). National study of HIV in pregnancy and childhood collaborative HIV paediatric study. Decline in mortality, AIDS, and hospital admissions in perinatally HIV-1 infected children in the United Kingdom and Ireland. British Medical Journal, 327, 1019. doi:10.1136/bmj.327.7422.1019.PubMedCrossRefGoogle Scholar
  14. Gill, C., Hamer, D., Simon, J., Thea, D., & Sabin, L. (2005). No room for complacency about adherence to antiretroviral therapy in Sub-Saharan Africa. AIDS (London, England), 19, 1243–1249. doi:10.1097/01.aids.0000180094.04652.3b.Google Scholar
  15. Ginsburg, A. S., Miller, A., & Wilfert, C. M. (2006). Diagnosis of pediatric human immunodeficiency virus infection in resource-constrained settings. The Pediatric Infectious Disease Journal, 11, 1057–1064. doi:10.1097/01.inf.0000243157.16405.f0.CrossRefGoogle Scholar
  16. Fairley, C. K., Permana, A., & Read, T. (2005). Long-term utility of measuring adherence by self-report compared with pharmacy record in a routine clinic setting. HIV Medicine, 6, 366–369. doi:10.1111/j.1468-1293.2005.00322.x.PubMedCrossRefGoogle Scholar
  17. Farley, J. J., Hines, S. E., Musk, A. E., Ferrus, S. E., & Tepper, V. E. (2003). Assessment of adherence to antiviral therapy in HIV-infected children using the medication event monitoring system (MEMS) compared with pharmacy refill, provider assessment, and caregiver self-report, and appointment keeping. Journal Acquired Immune Deficiency Syndrome, 33, 211–218. doi:10.1097/00126334-200306010-00016.CrossRefGoogle Scholar
  18. Katko, E., Johnson, G., Fowler, S., & Turner, R. (2001). Assessment of adherence with medications in human immunodeficiency virus-infected children. The Pediatric Infectious Disease Journal, 20, 1174–1176. doi:10.1097/00006454-200112000-00017.PubMedCrossRefGoogle Scholar
  19. Kline, M. W. (2006). Perspectives on the pediatric HIV/AIDS pandemic: Catalyzing access of children to care and treatment. Pediatrics, 4, 1388–1393. doi:10.1542/peds.2005-1348.CrossRefGoogle Scholar
  20. Kumarasamy, N., Safren, S. A., Raminani, S. R., Pickard, R., James, R., Krishnan, A. K., et al. (2005). Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: A qualitative study. AIDS Patient Care and STDs, 19, 526–537. doi:10.1089/apc.2005.19.526.PubMedCrossRefGoogle Scholar
  21. Marston, M., Zaba, B., Salomon, J. A., Brahmbhatt, H., & Bagenda, D. (2005). Estimating the net effect of HIV on child mortality in African populations affected by generalized HIV epidemics. Journal Acquired Immune Deficiency Syndrome, 38, 219–227. doi:10.1097/00126334-200502010-00015.CrossRefGoogle Scholar
  22. Martin, S., Elliott-DeSorbo, D. K., Wolters, P. L., Toledo-Tamula, M. A., Roby, G., Zeichner, S., et al. (2007). Patient, caregiver and regimen characteristics associated with adherence to highly active antiretroviral therapy among HIV- infected children and adolescents. The Pediatric Infectious Disease Journal, 26, 61–67. doi:10.1097/01.inf.0000250625.80340.48.PubMedCrossRefGoogle Scholar
  23. Mellins, C. A., Brackis-Cott, E., Dolezal, C., & Abrams, E. J. (2004). The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children. The Pediatric Infectious Disease Journal, 23, 1035–1041. doi:10.1097/ Scholar
  24. Mills, E. J., Nachega, J. B., Buchan, I., Orbinski, J., Attaran, A., Singh, S., et al. (2006a). Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis. Journal of the American Medical Association, 6, 679–690. doi:10.1001/jama.296.6.679.CrossRefGoogle Scholar
  25. Mills, E. J., Nachega, J. B., Bangsberg, D. R., Singh, S., Rachlis, B., Wu, P., et al. (2006b). Adherence to HAART: A systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Medicine, 3, e438. doi:10.1371/journal.pmed.0030438.PubMedCrossRefGoogle Scholar
  26. Myer, L., Moodley, K., Hendricks, F., & Cotton, M. (2006). Healthcare providers’ perspectives on discussing HIV status with infected children. Journal of Tropical Pediatrics, 52, 293–295. doi:10.1093/tropej/fml004.PubMedCrossRefGoogle Scholar
  27. Myung, P., Pugatch, D., Brady, M. F., Many, P., Harwell, J. I., Lurie, M., et al. (2007). Directly observed highly active antiretroviral therapy for HIV-infected children in Cambodia. American Journal of Public Health, 97, 974–977. doi:10.2105/AJPH.2005.083253.PubMedCrossRefGoogle Scholar
  28. Nachega, J. B., Knowlton, A. R., Deluca, A., Schoeman, J. H., Watkinson, L., Efron, A., et al. (2006). Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults: A qualitative study. Journal Acquired Immune Deficiency Syndrome, 43(Suppl 1), S127–S133.CrossRefGoogle Scholar
  29. Newell, M. L., Coovadia, H., Cortina-Borja, M., Rollins, N., Gaillard, P., & Dabis, F. (2004). Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: A pooled analysis. Lancet, 364, 1236–1243. doi:10.1016/S0140-6736(04)17140-7.PubMedCrossRefGoogle Scholar
  30. Nicholson, O., Mellins, C., Dolezal, C., Brackis-Cott, E., & Abrams, E. J. (2006). HIV treatment-related knowledge and self-efficacy among caregivers of HIV-infected children. Patient Education and Counseling, 61, 405–410. doi:10.1016/j.pec.2005.05.006.PubMedCrossRefGoogle Scholar
  31. Orrell, C. (2005). Antiretroviral adherence in a resource-poor setting. Current HIV/AIDS Reports, 4, 171–176. doi:10.1007/s11904-005-0012-8.CrossRefGoogle Scholar
  32. Pontali, E., Feasi, M., Toscanini, F., Bassetti, M., De Gol, P., Nuzzolese, A., et al. (2001). Adherence to combination antiretroviral treatment in children. HIV Clinical Trials, 2, 466–473. doi:10.1310/TA3G-JULH-B63D-VBBN.PubMedCrossRefGoogle Scholar
  33. Reddington, C., Cohen, J., Baldillo, A., Toye, M., Smith, D., Kneut, C., et al. (2000). Adherence to medication regimens among children with human immunodeficiency virus infection. The Pediatric Infectious Disease Journal, 19, 1148–1153. doi:10.1097/00006454-200012000-00005.PubMedCrossRefGoogle Scholar
  34. Steele, R. G., Nelson, T. D., & Cole, B. P. (2007). Psychosocial functioning of children with AIDS and HIV infection: Review of the literature from a socioecological framework. Journal of Developmental and Behavioral Pediatrics, 28, 58–69. doi:10.1097/DBP.0b013e3181132008.PubMedCrossRefGoogle Scholar
  35. Steyerberg, E. W., Eijkemans, M. J., Harrell, F. E., Jr, & Habbema, J. D. (2000). Prognostic modelling with logistic regression analysis: A comparison of selection and estimation methods in small data sets. Statistics in Medicine, 19, 1059–1079. doi:10.1002/(SICI)1097-0258(20000430)19:8<1059::AID-SIM412>3.0.CO;2-0.PubMedCrossRefGoogle Scholar
  36. Stirratt, M. J., Remien, R. H., Smith, A., Copeland, O. Q., Dolezal, C., Krieger, D., et al. (2006). The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS and Behavior, 5, 483–493. doi:10.1007/s10461-006-9106-6.CrossRefGoogle Scholar
  37. UNAIDS/WHO (2006). AIDS epidemic update. December 2006. Accessed from Date accessed 10th May 2007.
  38. Van Dyke, R. B., Lee, S., Johnson, G. M., Wiznia, A., Mohan, K., Stanley, K., et al. (2002). Pediatric AIDS clinical trials group adherence subcommittee pediatric AIDS clinical trials group 377 study team reported adherence as a determinant of response to highly active antiretroviral therapy in children who have human immunodeficiency virus infection. Pediatrics, 109, e61. doi:10.1542/peds.109.4.e61.PubMedCrossRefGoogle Scholar
  39. Wamalwa, D. C., Farquhar, C., Obimbo, E. M., Selig, S., Mbori-Ngacha, D. A., Richardson, B. A., et al. (2007). Early response to highly active antiretroviral therapy in HIV-1 infected Kenyan children. Journal Acquired Immune Deficiency Syndrome, 45, 311–317.Google Scholar
  40. Wiener, L., Mellins, C. A., Marhefka, S., & Battles, H. B. (2007). Disclosure of an HIV diagnosis to children: History, current research, and future directions. Journal of Developmental and Behavioral Pediatrics, 2, 155–166. doi:10.1097/ Scholar
  41. Williams, P. L., Storm, D., Montepiedra, G., Nichols, S., Kammerer, B., Sirois, P. A., et al. (2006). Predictors of adherence to antiretroviral medications in children and adolescents with HIV infection. Pediatrics, 118, e1745–e1757.PubMedCrossRefGoogle Scholar
  42. World Health Organization (2007). Toward universal access: Scaling up priority interventions in the health sector: progress report, April 2007. Accessed 15th May 2007.

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Julie Polisset
    • 1
  • Francine Ametonou
    • 1
  • Elise Arrive
    • 1
  • Anthony Aho
    • 2
  • Freddy Perez
    • 1
  1. 1.Institut de Santé Publique, d’Epidémiologie et de Développement (ISPED)Université Victor Segalen Bordeaux 2Bordeaux CedexFrance
  2. 2.Association, Action contre le SIDALomeTogo

Personalised recommendations