Influences on Adherence Influences on Adherence in children and families living in children and families living with HIV: with HIV: Psychosocial and developmental factors CHIVA / KZN Support & Mentoring Initiative CHIVA / KZN Support & Mentoring Initiative
Influences on Adherence in children and families living with HIV: Psychosocial and developmental factors. CHIVA / KZN Support & Mentoring Initiative. Adherence: What is it?. Adherence to ARVs means:. Taking ARVs exactly as directed, everyday – always! At the correct time - PowerPoint PPT Presentation
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Influences on AdherenceInfluences on Adherencein children and families living with in children and families living with
HIV:HIV:
Psychosocial and developmental factors
CHIVA / KZN Support & Mentoring InitiativeCHIVA / KZN Support & Mentoring Initiative
Taking ARVs exactly as directed, everyday – always!
At the correct time At the correct dose With or without food as directed Taking every dose of the medicine
No missed doses
Adherence to ARVs means:
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Adherence: What is it?Adherence: What is it?
Attending on the correct date for clinic appointment
Attending on the correct time for clinic appointment
Following dietary advice Taking Bactrim prophylaxis Getting depo-provera injection for
women of childbearing age taking Efavirenz (Stocrin)
Adherence to care and treatment
means:
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Children are neither mini Children are neither mini adultsadults
nor are they all the same!
Different approaches are required at Different approaches are required at
different ages and in different contextsdifferent ages and in different contexts
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Adherence: Evidence and Adherence: Evidence and AdviceAdvice
Adherence is a complex process requiring practical and psychosocial interventions
Not always related to severity of illness or impact on life
Difficult to measure Social and family factors important –
communication styles and nature of support Issues of ‘control’ may be important for older
children Sharing responsibility Adolescence – often levels of adherence are
poorest during this time
from research on chronic illness
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theconditionor illness
youngperson
parentcarerfamily
widersystem
community
thetreatment
task
The Wheel of InfluencesThe Wheel of Influences
TAKINGTAKINGTHE THE
PILLS!PILLS!
illnessepisodes,
stigmatising
temperament,age,
needs
understanding
control
communicationstyle
carer strengths and vulnerabilities
attitudesand beliefs
availablesupport
relationshipwith healthproviders
size, numbercolour, frequency,
side-effects
taking medicines is a taking medicines is a concern in all chronic concern in all chronic
illnesses!illnesses!
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What is known:What is known:
Those to do with medicines
Main influences
Those to do with the young person
Those to do with the family
Those to do with the community
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Adherence: Evidence and Adherence: Evidence and AdviceAdvice
Taste, size, frequency, number of pills, volume of liquid, colour
When and how to take (access to water, storage etc)
Consequences – immediate and longer-term
Being open / hiding medicines Prophylactic medicines don’t
always show immediate benefits
factors to do with medicines
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Adherence: Evidence and Adherence: Evidence and AdviceAdvice
Anxiety and / or confusion causing vulnerability
Prior negative experiences of being ill, taking medicines etc.
Understanding of the reasons for taking medicines
Who is there to support the young person?
Other behavioural or developmental difficulties
factors to do with the young person
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Adherence: Evidence and Adherence: Evidence and AdviceAdvice
Has there been continuity of care for the child?
How are the child’s general routines and behaviour managed?
Who else in the family is taking medicine, and how well have they been managing?
How does the family communicate together and with the child?
Are there other demands on the family such as other children or practical problems
Beliefs about condition and medicines
factors to do with the family
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Adherence: Evidence and Adherence: Evidence and AdviceAdvice
HIV specific factors Stigmatism and associations surrounding HIV
Affects secrecy and access to support Affects child’s knowledge about what is happening Adverse or negative experiences when HIV in family
Family Condition Losses in family Changes in circumstances and carers Who else in community can support child and carer? Contact with others living with HIV Successful role models and support networks Practical resources (such as storing medicines)
ARV medicines are demanding and need to be taken every day, every day, every day . . . . .
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Adherence Support:Adherence Support:Practical and psychological approaches
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Enhancing Adherence:Enhancing Adherence:
Welcome honesty when discussing difficulties with medicine taking
Talk about things having negative influence on adherence (such as hiding medicines)
Identify who is sharing responsibility with the child
Avoid blaming children or labelling families as ‘bad’ adherers – it’s a difficult task
Regular contact Leaflets Charts Pill swallowing Training
parents/carers Updates about HIV Updates about
medicine Groups for peer
support and education
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AdherenceAdherence
Keeping well How the immune system works What is HIV Prevention and transmission Why medication has been started How the medication works Measures: CD4 count / Viral load Discuss meanings of ‘undetectable’ and
‘resistance’
Motivational approaches
Psycho-Educational Component
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SummarySummary
Adherence is not a single event Many factors contribute to successful adherence,
but confidence and praising success are important Maintaining adherence is often more difficult than
starting well Open communication and support in family is as
important as child’s knowledge of HIV Give more responsibility to child as age increases,
but should still have someone to share the responsibility with
Update child’s knowledge about HIV and medicines directly as age increases – use of pictorial materials