Introduction:
Children below the age of 15 years account for the majority of acquired immunodeficiency syndrome (AIDS)-related deaths in Nepal. Antiretroviral therapy (ART) improves health and prolongs lives of people with human immunodeficiency virus (HIV). Poor adherence to ART provides clue to a sub-therapeutic level of antiretroviral drug, which can facilitate multi-drug resistance of similar regimen, leading to treatment failure and death. The objective of this study was to determine the level of adherence to ART and its associated factors among HIV-infected children aged 0-14 years in Pokhara Academy of Health Sciences (PoAHS), Pokhara, Nepal.

Material and methods:
This cross-sectional study was conducted between September 15th, 2020 and February 15th, 2021, and included 57 HIV-infected children. Caregivers of the children were questioned with a pre-tested, semi-structured questionnaire, which was later translated verbally to Nepali. Trained doctors took the interviews. Acquired data was entered using SPSS version 17 software for analysis. Level of significance was set at p < 0.05.

Results:
Caregiver’s forgetfulness was the main reason for missing ART doses (60%; 6/10). Other reasons were side effects of drug-related fear (30%; 3/10), followed by transportation problems (10%; 1/10). Older children (range, 11-14 years) adhered more to ART than younger ones (aged 0-5 and 6-10 years), with COR = 4.80 and 1.16, and 95% CI: 0.81-28.15% and 0.19-6.88%, respectively. Caregivers who knew their HIV status had their children more adherent to ART than those with unknown HIV status (COR = 27.94, 95% CI: 1.23-634.62%). A significant proportion of children in ART unit of PoAHS (17.54%; 10/57) missed ART doses within the previous week.

Conclusions:
The level of non-adherence to antiretroviral therapy in children was found to be 17.54%. Caregiver’s forgetfulness, side effects of drug-related fear, and transportation problems were the most common causes of non-adherence. Encouraging caregivers to know their HIV status, providing medi­cines via nearby ART clinics with coordination of community-based support, and using clues as a reminder to provide the child with drugs at the same time of the day, increase ART adherence in pediatric HIV-positive patients.