ORIGINAL RESEARCH

 

Nigerian health workers' views concerning factors influencing paediatric adherence to anti-retroviral therapy

 

 

Valerie J. Ehlers; Robert J. Chiegil

Department of Health Studies, University of South Africa, South Africa

Correspondence

 

 

---

ABSTRACT

Few studies have focused on paediatric anti-retroviral therapy (ART) adherence in Nigeria, probably because of the ethical challenges involved in studying children. The study aimed to identify factors that influence paediatric ART adherence as perceived by health care workers providing ART services in two cities in Nigeria. Knowledge about such factors would be used to formulate recommendations for enhancing paediatric ART adherence in Nigeria, for facilitating the tasks of the health care workers and for enhancing the ART programme's effectiveness. An exploratory descriptive qualitative research design was used to identify and to describe health care workers' views in Kano and Lagos, Nigeria. Three focus group discussions were conducted at two clinics that provide free paediatric ARVs (antiretroviral drugs). The transcribed data were analysed by using the framework approach of data analysis. Health care providers perceived poverty, illiteracy, stigma, discrimination, inappropriate care approaches, and parental dynamics as factors that influence paediatric ART adherence. Paediatric ART adherence levels in Nigeria could be enhanced by emphasising paediatric ART adherence counselling and by adopting a comprehensive family centred care approach, by improving free paediatric ART services and by empowering parents and reducing stigma and discrimination.

---

OPSOMMING

Min studies het al op pediatriese anti-retrovirale behandeling (ARB) nakoming in Nigerië gefokus, wat moontlik toegeskryf kan word aan die etiese uitdagings betrokke by die bestudering van kinders. Die studie het gepoog om faktore te identifiseer wat pediatriese ARB nakoming kan beïnvloed, soos waargeneem deur gesondheidsdienswerkers wat ARB dienste verskaf in twee stede in Nigerië. Kennis van sulke faktore sal aangewend word om aanbevelings te maak om die pediatriese ARB nakoming in Nigerië te verbeter, om die taak van die gesondheidsorgwerkers te vergemaklik en om die ARM (anti-retrovirale medisyne) program se doeltreffendheid te verbeter. 'n Verkennende beskrywende kwalitatiewe navorsingsontwerp was benut ten einde gesondheidswerkers in Kano en Lagos, Nigerië, se standpunte te identifiseer en te beskryf. Drie fokusgroepbesprekings is gehou in twee klinieke wat gratis ARMs verskaf. Die getranskribeerde data is ontleed deur die raamwerkbenadering tot data analise te gebruik. Gesondheidsdienswerkers het waargeneem dat armoede en ongeletterdheid, stigma en diskriminasie, ontoepaslike sorgbenaderings en ouerlike dinamika, faktore was wat pediatriese ARB nakoming beïnvloed het. Pediatriese ARB nakomingsvlakke in Nigerië kan verbeter word deur pediatriese ARB nakomingsberading te beklemtoon, deur die aanvaarding van 'n omvattende gesinsgesentreerde sorgbenadering wat gratis ARB dienste bied, deur die verbetering van ARB dienste, die bemagtiging van ouers en die vermindering van stigma en diskriminasie.

---

 

 

“Full text available only in PDF format”

 

 

References

Ammassari, A., Trotta, M.P.T., Murri, R., Castelli, F., Narciso, P., Noto, P., Vecchiet, J., Monforte, A.D., Wu, A.W. & Antinori, A., 2002, 'Correlates and Predictors of Adherence to Highly Active Antiretroviral Therapy: Overview of Published Literature', Journal of Acquired Immune Deficiency Syndrome 31(3), S123-S127. doi:10.1097/00126334-200212153-00007        [ Links ]

Bekker, L.G., Myer, L., Orrell, C., Lawn, S. & Wood, R., 2006, 'Rapid Scale-up of a Community-based HIV Treatment Service: Programme Performance over 3 Consecutive Years in Guguletu, South Africa', South Africa Medical Journal 96(4), 315-320. PMid:16670804        [ Links ]

Bikaako-Kajura, W., Luyirika, E., Purcell, D.W., Downing, J., Kaharuza, F., Mermin, J., Malamba, S. & Bunnell, R., 2006, 'Disclosure of HIV status and Adherence to Daily Drug Regimens among HIV-infected Children in Uganda', AIDS and Behavior 10(1007), s85, viewed 24 February 2009, from http://www.springerlink.com/content/e136m54785385337/        [ Links ]

Bless, C. & Higson-Smith, C., 2000, Fundamentals of social research methods: an African perspective, Juta, Lansdowne.         [ Links ]

Brackis-Cott, E., Mellins, C.A., Abrams, E., Reval, T. & Dolezal, C., 2003, 'Paediatric HIV Medication Adherence: the Views of Medical Providers from two Primary Care Programs', Journal of Paediatric Health Care 17(5), 252-260. doi:10.1016/S08915245(02)88313-4        [ Links ]

Burns, N. & Brove, S.K., 2001, The practice of nursing research: conduct, critique & utilization, W.B. Saunders, Philadelphia.         [ Links ]

Byrne, M., Honig, J., Jurgrau, A., Heffernan, S.M. & Donahue, M.C., 2002, 'Achieving Adherence with ARV Medications for Paediatric HIV Disease', AIDS Read 12(4), 151-154, 161-164. PMid:12071185        [ Links ]

Ellis, J. & Molyneux, E.M., 2007, 'Experience of Anti-retroviral Treatment for HIV-infected Children in Malawi: the first 12 Months', Annals of Tropical Paediatrics 27(4), 261-267. doi:10.1179/146532807X245643, PMid:18053342        [ Links ]

Giacomet, V., Albano, F., Starace, F., De Franciscis, A., Giaquinto, C., Gattinara, G.C., Bruzzese, E., Gabiano, C., Galli, L., Vigano, A., Caselli, D. & Guarino, A., 2003, 'Adherence to Antiretroviral Therapy and its Determinants in Children with Human Immunodeficiency Virus Infection: a Multicentre, National Study', Acta Paediatrica 92(12),1398-1402. doi:10.1111/j.1651-2227.2003.tb00822.x        [ Links ]

Greeff, M., Uys, L.R., Holzemer, W.L., Makoae, L.N., Dlamini, P.S., Kohi, T.W., Chirwa, M.L., Naidoo, J.R. & Phetlhu, R.D., 2008, 'Experiences of HIV/AIDS Stigma of Persons Living with HIV/AIDS and Nurses involved in their Care from five African Countries', Africa Journal of Nursing and Midwifery 10(1), 96, 102.         [ Links ]

Hammami, N., Nostlinger, C., Hoeree, T., Lefevre, P., Jonckheer, T. & Kolsteren, P., 2004, 'Integrating Adherence to Highly Active ART into Children's Daily Lives: a Qualitative Study', Paediatrics 114(5), e591-e597. doi:10.1542/peds.2004-0085, PMid:15520091        [ Links ]

Heath, K.V., Singer, J., O'shaughnessy, M.V., Motaner, J.S.G. & Hogg, R.S., 2002, 'Intentional Non Adherence due to Adverse Symptoms associated with Antiretroviral Therapy', Journal of Acquired Immune Deficiency Syndrome 31(2), 211-217. doi:10.1097/00126334-200210010-00012        [ Links ]

Kip, E., Ehlers, V.J. & Van der Wal, D.M., 2009, 'Nurses' Perceptions about Botswana Patients' Anti-retroviral Therapy Adherence', Health SA Gesondheid 14(1), 1-8.         [ Links ]

Kloos, H., Assefa, Y., Adugna, A., Mulatu, M.S. & Mariam, D.H., 2007, 'Utilization of ARV Treatment in Ethiopia between February and December 2006: Spatial, Temporal, and Demographic Patterns', International Journal of Health Geographics 6, 45. doi:10.1186/1476-072X-6-45, PMid:17894877, PMCid:2045665        [ Links ]

Laniece, I., Ciss, M., Desclaux, A., Diop, K., Mbodj, F., Ndiaye, B., Sylla, O., Delaporte, E. & Ndoye, I., 2003, 'Adherence to HAART and its Principal Determinants in a Cohort of Senagalese Adults', AIDS 17(3),S103-S108, viewed 24 February 2009, from http://cat.inist.fr/?aModele=afficheN&cpsidt=15058476        [ Links ]

Lincoln, Y.S. & Guba, E.G., 1985, Naturalistic inquiry, Sage, Beverly Hills.         [ Links ]

Marhefka, S.L., Farley, J.J., Rodrigue, J.R., Sandrik, L.L., Sleasman, J.W. & Tepper, V.J., 2004, 'Clinical Assessment of Medication Adherence among HIV-infected Children: examination of the Treatment Interview Protocol (TIP)', AIDS Care 16(3):323-338. doi:10.1080/09540120410001665330, PMid:15203426        [ Links ]

Marhefka, S.L., Tepper, V.J., Brown, J.L. & Farley' J.J., 2006, 'Caregiver Psychosocial Characteristics and Children's Adherence to ART', AIDS Patient Care and STDs 20(6),429-437. doi:10.1089/apc.2006.20.429, PMid:16789856        [ Links ]

Martin, S., Elliott-De Sorbo, D.K., Wolters, P.L., Toledo-Tamula, M.A., Roby, G., Zeichner, S. & Wood, L.V., 2007, 'Patient, Caregiver and Regimen Characteristics associated with Adherence to Highly Active ART among HIV-infected Children and Adolescents', Paediatric Infectious Disease Journal 26(1), 61-67. doi:10.1097/01.inf.0000250625.80340.48, PMid:17195708        [ Links ]

Marston, B.J., Macharia, D.K., Nga'nga, L., Wangai, M., Ilako, F., Muhenje, O., Kjaer, M., Isavwa, A., Kim, A., Chebet, K., De Cock, K.M. & Weidle, P.J., 2007, 'A Program to provide Antiretroviral Therapy to Residents of an Urban Slum in Nairobi, Kenya', Journal of the International Association of Physicians in AIDS Care 6(2), 106-112. doi:10.1177/1545109707300688, PMid:17538002        [ Links ]

Mellins, C.A., Brackis-Cott, E., Dolezal, C. & Abrams, E.J., 2004, 'The role of Psychosocial and Family Factors in Adherence to ARV-treatment in Human Immunodeficiency Virus-infected Children', Paediatric Infectious Disease Journal 23(11), 1035-1041. doi:10.1097/01.inf.0000143646.15240.ac, PMid:15545859        [ Links ]

Mdondolo, N., De Villiers, L. & Ehlers, V.J., 2003, 'Cultural Factors associated with the Management of Breast Lump amongst Xhosa Women', Health SA Gesondheid 8(3), 86-97.         [ Links ]

Mukhtar-Yola, M., Adeleke, S., Gwarzo, D. & Ladan, Z.F., 2006, Preliminary Investigation of Adherence to ART among Children in Aminu Kano Teaching Hospital, Nigeria. African Journal of AIDS Research 5(2),141-144. doi:10.2989/16085900609490374        [ Links ]

Nabukeera-Barungi, N., Kalyesubula, I., Kekitiinwa, A., Byakika-Tusiime, J. & Musoke, P., 2007, 'Adherence to ART in Children attending Mulago Hospital, Kampala', Annals of Tropical Paediatrics 27(2), 123-131. doi:10.1179/146532807X192499, PMid:17565809        [ Links ]

NACA: see National Agency for the Control of AIDS. National Agency for the Control of AIDS, 2008, Progress towards universal access to HIV prevention, treatment, care and support, viewed 21 February 2009 from http://www.naca.gov.ng/index2.php?option=com_docman&task=doc_view&gid=18&Itemid=99999999        [ Links ]

Pontali, E., 2005, 'Facilitating Adherence to Highly Active ART in Children with HIV Infection: what are the issues and what can be done'? Paediatric Drugs 7(3), 137-149. doi:10.2165/00148581-200507030-00001, PMid:15977960        [ Links ]

Pope, C., Ziebland, S. & Mays, N., 2000, 'Qualitative Research in Healthcare: Analysing Qualitative Data', British Medical Journal 320(7227), 114-116. doi:10.1136/bmj.320.7227.114, PMid:10625273, PMCid:1117368        [ Links ]

Reddington, C., Cohen, J., Baldillo, A., Toye, M., Smith, D., Kneut, C., Demaria, A., Bertolli, J. & Hsu, H.W., 2000, 'Adherence to Medication Regimens among Children with Human Immunodeficiency Virus Infection', Paediatric Infectious Disease Journal 19(12), 1148-1153. doi:10.1097/00006454-200012000-00005, PMid:11144374        [ Links ]

Rosen, S., Ketlhapile, M., Sanne, I. & DeSilva, I.B., 2007, 'Cost to Patients of Obtaining Treatment for HIV/AIDS in South Africa', South African Medical Journal 97(7), 524-529. PMid:17805455        [ Links ]

Stommel, M. & Wills, C.E., 2004, Clinical research: concepts and principles for advanced practice nurses, Lippincott Williams & Wilkins, Philadelphia.         [ Links ]

Tindyebwa, D., Kayita, J., Musoke, P., Eley, B., Nduati, R., Coovadia, H., Bobart, R., Mbori-Ngacha, D. & Kieffer P.M., 2005, Handbook on paediatric AIDS in Africa, ANECCA, Uganda.         [ Links ]

UNICEF: see United Nations International Children's Emergency Fund. United Nations International Children's Emergency Fund, 2005, Children: The missing face of AIDS, a call to action, viewed 21 February 2009, from http://www.uniteforchildren.org/knowmore/files/U77HIV_letter.pdf        [ Links ]

Ehlers, V.J. & Chiegil, R.J., 2010,[Notes taken during inteview with healthcare workers]. Unpublished raw data.         [ Links ]

Van Oosterhout, J.J., Kumwenda, J.K., Hartung, T., Mhango, B. & Zijlstra, E.E., 2007, 'Can the Initial Success of the Malawi ART Scale-up Programme be Sustained? The example of Queen Elizabeth Central Hospital, Blantyre', AIDS Care 19(10), 1241-1246. doi:10.1080/09540120701403358, PMid:17886172        [ Links ]

Veinot, T.C., Flicker, S.E., Skinner, H.A., McClelland, A., Saulnier, P., Read, S.E. & Goldberg, E., 2006, 'Supposed to make you better but it doesn't really': HIV-positive Youths' Perceptions of HIV Treatment', Journal of Adolescent Health 38(3), 261-267. doi:10.1016/j.jadohealth.2005.03.008, PMid:16488824        [ Links ]

Wachholz, N.I. & Ferreira, J., 2007, 'Adherence to ART in Children: a study of Prevalence and Associated Factors', Cadernos de Saude Publica 3:S424-S434. doi:10.1590/S0102-311X2007001500010        [ Links ]

Ware, N.C., Idoko, J., Kaaya, S., Biraro, I.A., Wyatt, M.A., Agbaji, O., Chalamilla, G. & Bangsberg, D.R., 2009, 'Explaining Adherence Success in Sub-Saharan Africa: an Ethnographic Study', PloS Medicine 6(1), 0039-0047, viewed 24 February 2009, from http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.1000011        [ Links ]

Williams, P.L., Storm, D., Montepiedra, G., Nichols, S., Kammerer, B., Sirois, P.A., Farley, J. & Malee, K., 2006, 'Predictors of Adherence to ARV Medications in Children and Adolescents with HIV Infection', Paediatrics 118(6), e1745-e1757.         [ Links ]

 

 

Correspondence:
Valerie Ehlers
PO Box 65075
Erasmusrand, Pretoria 0165
South Africa
ehlervj@unisa.ac.za

Received: 27 July 2010
Accepted: 28 Feb. 2011
Published: 05 Sept. 2011