873 Psychoscoial Barriers to Adherence of Subsidised Art in Children & Adolescents, Kampala, Uganda

Abstract

The aim of this study was to establish poor adherence as the primary reason for treatment failure in HIV+ children receiving subsidized ART in Uganda. The study examined psychological, cultural and structural barriers to adherence which are of increasing relevance as HIV transitions to a chronic disease of childhood in this population.

This study was exploratory and cross sectional in nature. Quantitative data was obtained from 108 charts of patients who were receiving 2^nd line ART regimens to assess clinical parameters relating to treatment failure and viral resistance. Qualitative data was obtained from 35 semi-structured interviews, four focus group discussions and four key informant interviews with caregivers of patients and staff and was analyzed using the deductive framework approach.

Quantitative data confirmed that patients were frequently switched to more costly 2^nd line regimens due to poor adherence. The mean time to development of resistance on treatment was 2.5 years. Qualitative data outlined multiple culturally specific barriers to adherence with psychosocial factors such as stigma, disclosure and family dynamics emerging as strongly as structural factors such as medication tolerability, poverty and access. Vulnerable groups warranting comprehensive treatment. packages were identified.

This study outlines the major issues facing program planners as they enter the next phase of universal access to ART in resource limited settings. Improved adherence over time is essential to effective patient care as well as program sustainability. The psychosocial issues surrounding the care of patients with HIV are inadequately catered for and are pivotal in ensuring ART adherence.

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