effects of leisure activities and psychosocial support on medication adherence and clinic attendance among children on antiretroviral therapy

Emmanuel Adémólá Anígilájé,1 Othniel Joseph Dabit,1 Ruth Kashimana Tyovenda,2 Agnes Jane Emebolu,2 Augustine Aondohemba Agbedeh,2 Ayodotun Olutola,3 Omolara Olufunmilayo Anígilájé4 1Department of Paediatrics, Benue State University, 2Department of Paediatrics, Federal Medical Centre, Makurdi, Benue State, 3Centre for Clinical Care and Clinical Research, Maitama, Abuja, 4Department of Family Medicine, Federal Medical Centre, Makurdi, Benue State, Nigeria Background: Optimal adherence to antiretroviral therapy (ART) and retention-in-care are essential in HIV management. Through a Kiddies’ Club (KC), the study aimed at assessing the impact of social leisures and psychosocial support on ART adherence and clinic attendance in a pediatric ART program. Methods: This was a descriptive, longitudinal study, conducted at the Federal Medical Centre, Makurdi, Nigeria, from June 2011 to June 2012. It included 33 ART-experienced children and their caregivers. The study was supplemented with a qualitative focused group discussion, involving 12 discussants. ART adherence, clinic attendance, and clinical and immunoviralogical responses of the children to ART were noted at 6 months and at 12 months of follow-up. Results: The children comprised 17 males and 16 females, with a median age of 5 years. Financial constraint was the most common reason given for losses to follow-up in quantitative (32/33, 96.9%) and qualitative (12/12, 100.0%) assessments. But, unavailability of means of transportation may still override the benefit that financial assistance can provide, as reported in the qualitative study. The baseline mean hemoglobin level (8.50 g/dL), median CD4 count (187.00 cells/mm3); median weight for height z-score (−0.395), and the median body mass index (15.40) increased significantly to respective values of 10.03 g/dL, 1,030.00 cells/mm3, −0.090, and 18.50, at 6 months (P-values: 0.000), and 10.47 g/dL, 1,203.00 cells/mm3, 0.420, and 19.20, at 12 months (P-values: 0.000). The baseline median viral load (45,678.00 copies/mL) also decreased significantly, to 200.00 copies/mL at 6 months and at 12 months (P-values: 0.000). There was no attrition from death or loss to follow-up, and adherence to ART was 100%, at 6 months and at 12 months of follow-up. Conclusion: Through the KC, children were retained in care, with excellent adherence to ART, and good clinical and immunoviralogical responses to ART, even after being previously lost to follow-up. Keywords: retention-in-care, children, antiretroviral therapy, Makurdi, Nigeria