Browsing by Author "Kekitiinwa, Addy"

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    Adherence To Antiretroviral Therapy In Children Attending Mulago Hospital, Kampala
    (Annals of tropical paediatrics, 2007) Barungi, Nicolette Nabukeera; Kalyesubula, Israel; Kekitiinwa, Addy; Tusiime, Jayne Byakika; Musoke, Philippa
    Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala.To determine the levels of adherence to HAART and identify factors associated with non-adherence.A cross-sectional study of 170 children aged 2–18 years. Adherence to HAART was defined as taking ≥95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2–3 weeks later.The 3-day self-reported ≥95% adherence was 89.4% (n=170). Using clinic-based pill counts, 94.1% (n=170) had ≥95% adherence to treatment compared with only 72% (n=164) by unannounced pill counts. When the primary caregiver was the only one who knew the child's serostatus, he/she was three times more likely to be non-adherent (p=0.02, OR 3.34, 95% CI 1.14–9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have ≥95% adherence (p=0.02, OR 0.44, 95% CI 0.20–0.92). The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child's HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.
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    Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala
    (Annals of tropical Paediatrics, 2007) Nabukeera-Barungi, Nicolette; Kalyesubula, Israel; Kekitiinwa, Addy; Byakika-Tusiime, Jayne; Musoke, Philippa
    Background: Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala. Aim: To determine the levels of adherence to HAART and identify factors associated with non-adherence. Methods: A cross-sectional study of 170 children aged 2–18 years. Adherence to HAART was defined as taking >95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2–3 weeks later. Results: The 3-day self-reported >95% adherence was 89.4% (n5170). Using clinic-based pill counts, 94.1% (n5170) had >95% adherence to treatment compared with only 72% (n5164) by unannounced pill counts. When the primary caregiver was the only one who knew the child’s serostatus, he/she was three times more likely to be non-adherent (p50.02, OR 3.34, 95% CI 1.14–9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have >95% adherence (p50.02, OR 0.44, 95% CI 0.20–0.92). Conclusion: The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child’s HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.
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    Differences in Factors Associated With Initial Growth, CD4, and Viral Load Responses to ART in HIV-Infected Children in Kampala, Uganda, and the United Kingdom/Ireland
    (JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008) Kekitiinwa, Addy; Lee, Katherine J.; Walker, Sarah; Maganda, Albert; Doerholt, Katja; Kitaka, Sabrina B.; Asiimwe, Alice; Judd, Ali; Musoke, Philippa; Gibb, Diana M.
    Few studies have directly compared response to antiretroviral therapy (ART) between children living in well-resourced and resource-limited settings. In resource-limited settings non-HIV contributors could reduce the beneficial effects of ART. We compare predictors of short-term immunological, virological, and growth response to ART in HIV-infected children in the United Kingdom/Ireland and Kampala. Methods: We analyzed prospective cohort data from 54 UK/Irish hospitals (the Collaborative HIV Paediatric Study) and Mulago Hospital, Kampala, Uganda. Six- and 12-month responses are described among children initiating combination ART (≥3 drugs, ≥2 classes). Six months post-ART, predictors of viral load (VL) suppression <400 copies/mL, CD4% increases >10%, and height- and weight-for-age z-score increases ≥+0.5 were investigated using logistic regression.In all, 582 UK/Irish children (76% black African) were younger than 876 Kampala children at ART initiation (median 5.0 vs 7.6 years), with higher CD4% (14%, 8%), lower VL (172,491 and 346,809 copies/mL), and less stunting (−0.8, −2.8) and wasting (−0.6, −2.8). Post-ART, median 12-month changes in the United Kingdom/Ireland and Kampala in CD4% (+12%, +13%) and weight (+0.4, +0.5) were similar, but growth was less in Kampala (+0.20, +0.06, P < 0.001). Younger children in both cohorts had better immunological, weight, and growth responses (all P < 0.001). However, lower pre-ART CD4% predicted better immunological response in the United Kingdom/Ireland but poorer response in Kampala (heterogeneity P = 0.004). Although 70% children in both cohorts had suppressed <400 copies/mL at 6 months, adolescents starting ART in the United Kingdom/Ireland had somewhat poorer VL responses than those in Kampala (P = 0.15). In all, 582 UK/Irish children (76% black African) were younger than 876 Kampala children at ART initiation (median 5.0 vs 7.6 years), with higher CD4% (14%, 8%), lower VL (172,491 and 346,809 copies/mL), and less stunting (−0.8, −2.8) and wasting (−0.6, −2.8). Post-ART, median 12-month changes in the United Kingdom/Ireland and Kampala in CD4% (+12%, +13%) and weight (+0.4, +0.5) were similar, but growth was less in Kampala (+0.20, +0.06, P < 0.001). Younger children in both cohorts had better immunological, weight, and growth responses (all P < 0.001). However, lower pre-ART CD4% predicted better immunological response in the United Kingdom/Ireland but poorer response in Kampala (heterogeneity P = 0.004). Although 70% children in both cohorts had suppressed <400 copies/mL at 6 months, adolescents starting ART in the United Kingdom/Ireland had somewhat poorer VL responses than those in Kampala (P = 0.15).
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    Sexual risk reduction needs of adolescents living with HIV in a clinical care setting
    (Routledge, 2008) Bakeera-Kitaka, Sabrina; Nabukeera-Barungi, Nicolette; Nöstlinger, Christiana; Kekitiinwa, Addy; Colebunders, Robert
    As anti-retroviral therapy becomes increasingly available, young people living with HIV need tailored support to adopt healthy sexual behaviors. There has been a gap in the availability of culturally appropriate techniques for secondary prevention and sexual risk reduction in this target group. This formative study assessed sexual and reproductive health needs and problems, as well as determinants of sexual risk-taking among young people living with HIV aged 11 21 years attending the Paediatric Infectious Disease Clinic in Kampala, Uganda. Theoretical guidance was provided by the Information-Motivation-Behavioral Skills Model. Socio-demographic and selected psychosexual data were assessed using a brief anonymous questionnaire. A total of 75 young people living with HIV participated in eight focus group discussions. In addition, one focus group was conducted with adult key informants (service providers). About a quarter of the young participants reported prior or current sexual experience. The study revealed knowledge gaps relating to reproductive health, HIV transmission, and contraceptive methods. Motivations for protection included hope for the future, good counseling, and fear of the consequences of sexual activity such as unwanted pregnancies. Barriers to adopting preventive behaviors included peer pressure, poverty, HIV-related stigma, ignorance of their partners, alcohol use, and a desire to have children for the older ones. Young sero-positive people in this setting lacked specific behavioral skills, such as disclosure of HIV status to their sexual partners, this being closely linked to fear of rejection and stigma. HIVpositive youths need support in developing the appropriate behavioral skills to adopt healthy sexual behaviors. Interventions in this field need to be developmentally appropriate and tailored to young people’s specific needs. Structural interventions should at the same time address and reduce HIV-related stigma and socio-economic needs of young people living with HIV.