Abstract
The human immunodeficiency virus (HIV) is an infection that attacks the body’s immune system, specifically the white blood cells called CD4 cells, leading to extreme immune suppression and a continuous loss of cells. Untreated HIV eventually increases the risk of new opportunistic infections such as tuberculosis and cryptococcal meningitis, and can progress to acquired immunodeficiency syndrome (AIDS). Children infected with HIV have an exceptionally high risk of morbidity and mortality compared to adults due to the immature state of their immune systems when acquiring the virus, which increases both mortality and morbidity rates. However, antiretroviral therapy (ART) has transformed HIV from a fatal disease into a manageable chronic condition. ART treatment aims to increase life expectancy and reduce the risk of HIV transmission. However, this can only be achieved if HIV positive children and patients adhere to treatment. Adherence to ART is a critical determinant of survival.
The purpose of this study was to determine and describe the factors that impact children's adherence to ART in Ekurhuleni and to make recommendations to PHC nurses working with children on ART to develop interventions to improve child ART adherence.
A quantitative, descriptive, non-experimental and contextual design was used to determine the factors that impact adherence to ART among children. Convenience sampling method was used to determine the population for the study, which comprised 167 respondents. After approaching a population of 167 parents/guardians/caregivers (PGC), 157 respondents indicated their willingness to participate, and they signed a written consent form. These respondents completed a self-report questionnaire, which was used to collect data. The collected data were captured in an Excel spreadsheet and presented as descriptive statistics and frequency distributions using tables and figures. The statistician used the IBM SPSS Statistics version 28 (2022) software program to analyse the data.
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The reliability and validity of the research instrument were ensured. Before data collection commenced, ethical clearance was obtained from the university, the Department of Health, and the primary healthcare (PHC) facilities. The researcher also adhered to the ethical principles of informed consent and autonomy, beneficence, non-maleficence, and the principle of justice throughout the study.
The study revealed that all the factors explored can have both positive and negative impacts on adherence to ART. The majority of the PGC experienced ART to be beneficial and were satisfied with the service they received from PHC facilities. However, barriers such as unemployment, forgetfulness and lack of knowledge about ART and the importance of adherence could be setbacks to their children’s ART adherence. The study’s findings provided an in-depth understanding of the factors that impact ART adherence among children in Ekurhuleni, Gauteng. It allowed the researcher to make recommendations for nurses working with children on ART to ensure sufficient knowledge and appropriate interventions to improve child ART adherence.
Adherence to ART among children remains a burden and a global challenge that requires targeted interventions. Consistent adherence is crucial for the effectiveness of ART in children, as it leads to viral suppression and improved health outcomes. Achieving this requires ongoing support from a competent multidisciplinary team, a mentally stable and well-informed PGC, and access to adequate food and nutrition.