Attendance of psychosocial teen clubs and self-reported antiretroviral medication adherence: a cross section study of adolescents with perinatal HIV in the Kingdom of Lesotho

<abstract><sec> <title>Background</title> <p>To address the problem of poor adherence among adolescents with perinatal HIV (PHIV), all clinics in Lesotho offer adolescent-friendly services and psychosocial support to improve their overall health outcomes and adherence. As a result, most adolescents with PHIV attend Teen Clubs as part of the package of youth-friendly HIV services. This study set out to determine whether attending Teen Clubs facilitates treatment adherence among adolescents with PHIV.</p> </sec><sec> <title>Methods</title> <p>In this cross-sectional study, data were collected from 130 adolescents aged 10–19 years who were aware of their HIV status and had attended three or more Teen Club sessions in selected clinics in rural district in Lesotho. Adherence was measured through self-report of last pills missed, based on the 7-days recall of pills taken. Descriptive statistics were used to analyse the data.</p> </sec><sec> <title>Results</title> <p>The median age of adolescents was 15 years, 56% were female, 37.7% were orphans, 41% were being cared for by their grandparents, 6.9% were living with siblings with no adult figure, and two were living on their own. The majority (93%) reported optimal adherence, 92% had not missed a clinic appointment in the past 30 days, and 74.4% knew that if they skipped doses, the viral load would increase and they would get sick. Over half (56%) had been reminded by their caregivers to take their medication and 96% talked to their caregivers regularly about their medication.</p> </sec><sec> <title>Conclusion</title> <p>A supportive environment provided through the Teen Clubs and in the home were the main facilitators for adherence. Strategies to improve adherence among adolescents should consider the importance of the involvement of caregivers in the adolescents' visits to their clinic.</p> </sec></abstract>

SP9 The KidzMed project part 1: pill popping heroes

BackgroundThere are large groups of children where families have problems obtaining ongoing supplies of their children’s medicines in primary care due to them being high risk and complex, unlicensed, off label or expensive. The KidzMeds project was established ‘For all children to get the right medicine at the right dose at the right time with the right monitoring with minimum fuss wherever they live.’Tablets are safer, more convenient and cheaper than liquid medications. Children often remain on liquid due to habit, reluctance and parental and staff not knowing how to convert. The idea of converting came from initial HIV medications which were only available in tablets1; children as young as 3 years could be taught.2 3AimQuality improvement project to teach children and young people (CYP) on long term medication how to take tablet medication in an out-patient setting.MethodWorking with families and our teams we created an interactive training package with video (http://northernpaediatrics.com/kidzmed/) and comic poster. We ran interactive hour-long training sessions for staff. Using positive reinforcement and play, the trainer sat facing the learner with sweets or dummy filled capsules of increasing sizes, from size 3 (15 mm) to size 00 (23 mm).Over the next 12 weeks in one team we embedded a process for children ≥5 years attending complex renal clinics to be converted from liquid to tablet medication unless contraindicated (e.g. swallowing or cognitive impairment).Outcome measures included successful conversion rate, patient and staff feedback and cost savings.We overcame practical barriers by placing easily accessible ‘switching kits’ in clinic filled with the necessary dummy pills, awards and certificates. To increase confidence, we created a sealed dosette box with common medications so children could see the size of tablets they needed to swallow. Working with the clinical team we standardised processes (e.g. how to round doses, pre-screening clinic lists and creating prompts).ResultsOver three months, 90 CYP were seen in 13 multi-disciplinary renal clinics, 25 were suitable for conversion to tablet medication. 21 CYP (median age 8.4 years range 5.1 to 15.5) were successfully converted (only one patient required two sessions). 36 medicines were switched, generating £46,500 per year recurrent savings.Feedback was good. Staff liked the opportunity for positive interaction with children and families appreciated the ease of obtaining tablet medications versus liquids. We subsequently trained other teams, including our research team who were recruiting for a study in which swallowing tablets is an inclusion criteria.ConclusionsIn a short timeframe it is possible to embed a system to convert children to tablet medication, improving patient experience and realising considerable cost savings. It requires staff training and cultural change. Pill swallowing is an easy skill to teach and learn and children as young as five can successfully swallow pills. We automatically teach inhaler technique so equally we should teach CYP how to swallow tablets as a skill for life. We would encourage all units to set up pill swallowing training.ReferencesFischl MA, et al. The efficacy of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. NEJM 1987;317:185–91Garvie PA. Efficacy of a pill-swallowing training intervention to improve antiretroviral medication adherence in pediatric patients With HIV/AIDS. Pediatrics 2007;119:e893–e899Patel A, et al. Effectiveness of pediatric pill swallowing interventions: a systematic review. Pediatrics 2015;135:883–889

Cognitive-behavioural factors associated with adherence to antiretroviral medication among HIV infected patients in Ibadan, Oyo state

Background: The initiation of antiretroviral therapy has brought about a huge transformation in HIV care and it has helped in saving millions of lives since its inception. Nevertheless, non-adherence poses a huge challenge to HIV care as this exposes the patients to opportunistic infections and brings about highly resistant viral strains. Therefore, this study assessed the cognitive-behavioural factors associated with the adherence to antiretroviral medication among HIV infected patients in Ibadan, Oyo State, Nigeria.Methods: A descriptive cross sectional study design guided by a behavioural theory was employed. Multistage sampling was employed in this study. Purposive sampling was used to select the hospitals and simple random sampling was used to select the respondents. A 42 item semi-structured questionnaire validated at 0.85 Cronbach alpha was used. Data were analysed using descriptive and inferential statistics at p<0.05.Results: The result showed a mean age of 42.11±11.60 years, while 238 (82.6%) of the respondents were female. The study revealed a positive attitudinal disposition of 54% and a negative perception of 51.5%. Optimal antiretroviral medication adherence among the respondents was 189 (65.6%). Attitude and perception showed a statistical correlation towards antiretroviral medication adherence where p=0.001 and p=0.000 respectively.Conclusions: Attitude and perception are major cognitive-behavioural factors that predicts antiretroviral medication adherence, hence, health promotion intervention that could modify these factors and improve antiretroviral medication adherence is highly recommended.