Caregiver Reported Missed Doses of Antiretroviral Therapy in HIV-Infected

Children in Western Kenya

Michael L. Scanlon1,2; Winstone M. Nyandiko2,3; Wanzhu Tu1; Hai Liu1; James E. Slaven1; Sarah E. Wiehe1; Thomas S.

Inui1,2,3; Samuel O. Ayaya2,3;

Rachel C. Vreeman1,2,3

1Indiana University School of Medicine, Indianapolis, IN, USA2Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

3School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya

Objectives & Methods

Objective:To evaluate caregiver-reported missed doses as an adherence measurement strategy for HIV-infected children in care through a large HIV treatment program in Kenya

Methods: • Six-month prospective cohort study following 191 caregiver-child dyads • Monthly visits with study personnel who asked caregivers, “In the last

30 days, how many doses of HIV medicine has your child missed?”• Children’s nevirapine or efavirenz in bottles with Medication Event

Monitoring Systems (MEMS®) for electronic dose monitoring

Analyses: Used receiver operating characteristic (ROC) curves and multivariate logistic regression using MEMS® as adherence reference standard

Results & Conclusions

Results:Caregiver report performed poorly as indicator of non-adherence with low sensitivity and C-statistics

MEMS® Non-Adherence Thresholds

Sens Spec Area Under Curve

<100% .252 .962 .605

<90% .337 .903 .624

<80% .368 .863 .623

Table 1. ROC Results

Conclusions:• Caregivers significantly

underestimated their child’s missed doses

• Caregiver underestimates of non-adherence may reflect lack of knowledge about child’s daily medication intake

Several factors associated with caregivers underestimating child’s missed doses:• Child’s older age (OR 1.3, 95%CI 1.1-

1.6)• More people help give ART (OR 2.1,

95%CI 1.2-3.6)• Caregiver employed outside home (OR

2.6, 95%CI 1.3-5.2)• Child on EFV (vs. NVP) (OR 3.2, 95%CI

1.4-7.8) ????

Questions and Acknowledgements

Special thanks to: • AMPATH clinicians and nurses • CAMP study personnel • And most of all to the children and families who donated their time

and effort that made this study possible