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A treatment‐support intervention evaluated in South African paediatric populations with HIV infection or tuberculous meningitis
Author(s) -
Elsland Sabine L.,
Peters Remco P.H.,
Kok Maarten O.,
Toorn Ronald,
Springer Priscilla,
Cotton Mark F.,
Grobbelaar Cornelis J.,
Aarnoutse Rob,
Furth A. Marceline
Publication year - 2018
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.13134
Subject(s) - medicine , rifampicin , quality of life (healthcare) , pyrazinamide , tuberculous meningitis , intervention (counseling) , pill , pediatrics , meningitis , tuberculosis , psychiatry , nursing , pathology , pharmacology
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 Peds QL ™questionnaires for health‐related quality‐of‐life ( HRQ oL) and family impact. Results In the HIV group (6‐months follow‐up, n = 195), more children had above‐median HRQ oL‐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 HRQ oL‐scores between baseline and follow‐up, when the number of children with above‐median HRQ oL‐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.