Abstract
Objectives: To evaluate a paediatric treatment-support intervention for home-based treatment of HIV infection or tuberculous meningitis (TBM). Methods: A randomised-controlled study comparing local standard care (controls) with standard care plus intervention (combining adherence education, reinforcement and monitoring) in children aged 0–14 years. We recorded adherence measures (self-report, pill-count, drug-assays for isoniazid and rifampicin in urine and pyrazinamide in saliva), difficulties administering medication and PedsQL™questionnaires for health-related quality-of-life (HRQoL) and family impact. Results: In the HIV group (6-months follow-up, n = 195), more children had above-median HRQoL-scores in the intervention group than in the control group (P = 0.009). Problems reported administering medication declined between baseline and follow-up for controls (P = 0.043). Disclosure of HIV status to the child increased between baseline and follow-up in both groups (intervention P < 0.001; control P = 0.031). In the TBM group (3-months follow-up, n = 43), all adherence measures remained high for both intervention and controls, except for rifampicin which declined between baseline and follow-up in the intervention group (P = 0.031). The intervention group maintained above median HRQoL-scores between baseline and follow-up, when the number of children with above-median HRQoL-scores decreased in the controls (P = 0.063). More children in the intervention group had above-median family impact-scores than controls (P = 0.040). Conclusions: The low-cost, culturally friendly treatment-support intervention had beneficial effects on health-related quality of life, family impact, caregiver disclosure of HIV status to the child, increased caregiver reporting of medication non-adherence and caregiver reporting of difficulties administering medication. Treatment adherence was not significantly affected in either HIV or TBM group.
| Original language | English |
|---|---|
| Pages (from-to) | 1129-1140 |
| Number of pages | 12 |
| Journal | Tropical Medicine and International Health |
| Volume | 23 |
| Issue number | 10 |
| Early online date | 3 Aug 2018 |
| DOIs | |
| Publication status | Published - Oct 2018 |
Funding
The authors thank the study participants, the staff at Tygerberg Hospital, the staff at TC Newman Hospital, Anova Health Institute and also Mrs. P. Ketelo, Mrs. H. Lesch, Mrs. A. Hattingh and Mrs. Claassen. In addition, we thank Panton for the design of the intervention materials. The study was funded by the Mr. Backhuys Rooze-boom Stichting and the VU Medical Centre. The funder of the study had no role in study design, data collection, data analysis, data interpretation or writing of the manuscript. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Keywords
- child
- HIV
- intervention
- Paediatric
- treatment-support
- Tuberculous meningitis
