Discordance between providers estimated and caregivers self reported adherence to haart and immunological response among hiv infected children in Ethiopia

Abstract

Purpose: Poor concordance between patient and physician
reports of adherence might lead to inappropriate decisions
regarding therapy. This study was undertaken to determine the rate of discordance between caregivers of children and physicians on adherence to Highly Active Antiretroviral Therapy (HAART). Methods: In a cross sectional study involving 390 respondents that was conducted in five hospitals in Addis Ababa, agreement between caregiver-reported adherence and providers’ estimate of adherence was compared using Kappa (k) statistic. The association between the CD4 counts
and measure of adherence was evaluated using a receiver
operating characteristic (ROC) curve. Results: Caregivers reported dose adherence was 87% in the last 7 days and physician estimated 84% of the children as adherent based on their judgment. Fair agreement was observed between caregivers-reported dose adherence and
providers' estimate adherence (Kappa = 0.27, p=0.0001). In a ROC curve, the association between a current CD4 count slope and physician estimated was poor.
Conclusions: There is fair agreement and high rate of
discordance (18%) between physicians estimated and
caregivers reported adherence. These recall for an
intervention to augment better mutual understanding between physicians and caregivers on the issue of adherence to HAART under clinical care programme.

Keywords: Adherence; CD4 count; Discordance; HAART.