Background: Adherence to ART among children is a dynamic challenging process involving several factors. With use of effective ART therapy, survival of children with AIDS has extensively increased but the benefits of this therapy are limited by non-adherence. This study aimed at establishing the caregiver factors associated with adherence to ART among children infected with HIV at Kisugu Health Center III. Methodology: The study was carried out using a cross – sectional descriptive study design. The design used only quantitative methods of data collection while in the field and the study population included only caregivers of HIV sero – positive children at Kisugu Health Center III ART clinic by the time of the study and its where a sample of 188 respondents were selected by means of simple random sampling technique. Data was collected with use of pretested and structured questionnaires. Descriptive and summary statistics were employed. Uni-variate and Bi-variate logistic regressions and their 95% confidence intervals were computed to determine the level of statistical significance. Results: Less than half 40.4% of the caregivers indicated that their children were adherent to ART therapy in the last week preceding the interview. The study found out that primary caregivers relationship with the child (P=0.039], primary caregivers level of education (P=0.010), Social support (P=0.043) and ART counseling services (P=0.000) were independently associated with adherence. None of the treatment related factors was statistically significantly associated with adherence to ART among children. Conclusion Only 59.6 %(112) of pediatric patients had good adherence to ART in the previous week prior to study start. The fact that the primary caregiver was a parent of the infected child adversely affected adherence whereas adherence rates were seen to increase with increasing primary caregiver level of education. Recommendations Caregivers should be educated and provided with appropriate and accurate information on HIV/AIDS and about ART therapy as well as encourage support groups since social support improved adherence to ART therapy. There is thus need for assessments of the caregiver’s education level, relationship to the child and provision of social support and ART counseling services in an effort to ensure improved adherence to ART at Kisugu Health Center III.

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