Evaluating adherence to medication in children and adolescents with HIV

Khan, Munziba; Song, Xin; Williams, Keetra; Bright, Kimberly; Sill, Anne; Rakhmanina, Natella

doi:10.1136/adc.2008.156232

Cited by 41 publications

(34 citation statements)

References 23 publications

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“…Although similar VL-adherence associations have been reported in the pediatric and adult literature (Khan et al, 2009; Nieuwkerk & Oort, 2005; Simoni et al, 2006; Williams et al, 2006), the data here come from one of the largest cohort studies of PHIV+ youth in the US and thus lend support to the usefulness of self-reported adherence data in general and, more specifically, the validity of youth and caregiver reports of youth adherence. Adjusting for age and caregiver relationship, we found two indicators ( recall of one or more missed ARV doses in past 7 days and the question “ When was the last time you/your child missed your medications ?”) significantly associated with VL whether caregiver and youth responses were analyzed independently or combined.…”

Section: Discussionsupporting

confidence: 83%

Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection

et al. 2013

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Poor adherence to antiretroviral therapy (ART) contributes to disease progression and emergence of drug-resistant HIV in youth with perinatally acquired HIV infection (PHIV+), necessitating reliable measures of adherence. Although electronic monitoring devices have often been considered the gold standard assessment in HIV research, they are costly, can overestimate non-adherence and are not practical for routine care. Thus, development of valid, easily administered self-report adherence measures is crucial for adherence monitoring. PHIV+ youth aged 7–16 (n=289) and their caregivers, enrolled in a multisite cohort study, were interviewed to assess several reported indicators of adherence. HIV-1 RNA viral load (VL) was dichotomized into >/≤400 copies/ml. Lower adherence was significantly associated with VL >400 copies/ml across most indicators, including ≥ 1 missed dose in past 7 days [youth report OR=2.78 (95% CI 1.46–5.27)]. Caregiver and combined youth/caregiver reports yielded similar results. Within-rater agreement between various adherence indicators was high for both youth and caregivers. Inter-rater agreement on adherence was moderate across most indicators. Age ≥13 years and living with biological mother or relative were associated with VL > 400 copies/ml. Findings support the validity of caregiver and youth adherence reports and identify youth at risk of poor adherence.

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Section: Discussionsupporting

confidence: 83%

Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection

et al. 2013

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“…HIV infected adolescents face adherence challenges during their transition to adulthood like palatability issues, pill burden, interference of ART with lifestyles, adolescent HIV infected patients' growing independence, increased peer pressure, fear of stigmatization and other factors [38][39][40][41] . Pt3 was an adolescent who dropped out of school and eloped with a man, in South Africa, adolescents were less adherent to ART than adults 19 , while in the USA, adolescents (13-18 year old) were less likely to achieve undetectable viral loads than children less than 13 year old 20 , and in Haiti where HIV-infected youths and adolescents had poor ART adherence 21 . Pt4 was also an adolescent who had sexuality challenges, and the N. gonorrhoeae urethritis was proof of unprotected sexual intercourse.…”

Section: Discussionmentioning

confidence: 99%

“…Failure to disclose HIV serostatus, poor social and family support, concurrent use of other medications with ART have also been found to be associated with poor ART adherence [14][15][16][17][18] . Adolescents have been found to be less adherent to ART than adults and younger children, while orphanhood and lack of social support have also been reported to be associated with poor ART adherence 15,[19][20][21] . Standardised approaches are often used to enhance improvement in adherence to ART, however this may not be appropriate in all cases as this paper illustrates.…”

Section: Introductionmentioning

confidence: 99%

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

Mayanja¹,

Kabunga²,

Masiira³

et al. 2013

Afr H. Sci.

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Background: Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. Objectives: To study specific personal barriers to ART adherence. Methods: Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. Results: Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. Conclusions: ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

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“…Data suggest that adolescents have poorer adherence to ART when compared with younger children 221. In adolescents commencing first‐line therapy, a boosted PI ‐based regimen potentially reduces the risk of accumulating resistance mutations in the event of virological failure; however, such regimens have a higher pill burden than the FDCs based on NNRTIs or EVG which have a lower genetic barrier to resistance.…”

Section: Adolescence Mental Health and Transitionmentioning

confidence: 99%

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

et al. 2015

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The 2015 Paediatric European Network for Treatment of AIDS (PENTA) guidelines provide practical recommendations on the management of HIV‐1 infection in children in Europe and are an update to those published in 2009. Aims of treatment have progressed significantly over the last decade, moving far beyond limitation of short‐term morbidity and mortality to optimizing health status for adult life and minimizing the impact of chronic HIV infection on immune system development and health in general. Additionally, there is a greater need for increased awareness and minimization of long‐term drug toxicity. The main updates to the previous guidelines include: an increase in the number of indications for antiretroviral therapy (ART) at all ages (higher CD4 thresholds for consideration of ART initiation and additional clinical indications), revised guidance on first‐ and second‐line ART recommendations, including more recently available drug classes, expanded guidance on management of coinfections (including tuberculosis, hepatitis B and hepatitis C) and additional emphasis on the needs of adolescents as they approach transition to adult services. There is a new section on the current ART ‘pipeline’ of drug development, a comprehensive summary table of currently recommended ART with dosing recommendations. Differences between PENTA and current US and World Health Organization guidelines are highlighted and explained.

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Evaluating adherence to medication in children and adolescents with HIV

Abstract: In our study, pharmacy supply was not associated with self-reported adherence. Most importantly, adherence and age were significant predictors of reaching undetectable viral loads.

Cited by 41 publications

References 23 publications

Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection

Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection

Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

Paediatric European Network for Treatment of AIDS (PENTA) guidelines for treatment of paediatric HIV‐1 infection 2015: optimizing health in preparation for adult life

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