Medication Adherence in Adolescents With Behaviorally-acquired HIV: Evidence for Using a Multimethod Assessment Protocol

Garvie, Patricia A.; Wilkins, Megan L.; Young, Jim

doi:10.1016/j.jadohealth.2010.03.013

Cited by 32 publications

(32 citation statements)

References 29 publications

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“…The challenges associated with transitioning into adolescence are exacerbated by HIV infection, and can result in poor adherence, mental health conditions (e.g., depression), and high rates of loss to follow-up. 24–26 Unfortunately, we were not able to include adherence in the statistical models because we were missing adherence data from the time period immediately following second-line switch and before study enrolment. Interventions to ensure adherence and prevent treatment failure during adolescence are critical to prevent treatment failure, particularly when third-line options are limited.…”

Section: Discussionmentioning

confidence: 99%

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Prasitsuebsai

Teeraananchai²,

Singtoroj

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Data on pediatric treatment outcomes and drug resistance while on second-line antiretroviral therapy (ART) are needed to guide HIV care in resource-limited countries. Methods HIV-infected children <18 years old who were switched or switching to second-line ART after first-line failure were enrolled from eight sites in Indonesia, Thailand, and Vietnam. Genotyping was performed at virologic failure (VF; HIV-RNA >1000copies/mL). Cox proportional hazards regression was used to evaluate factors predicting VF. Results Of 277 children, 41% were female. At second-line switch, age was 7.5 (5.3–10.3) years, CD4 count was 300 (146–562) cells/mm3 and percentage was 13 (7–20)%; HIV-RNA was 5.0 (4.4–5.5) log10 copies/mL. Second-line regimens contained lamivudine (90%), tenofovir (43%), zidovudine or abacavir (30%), lopinavir (LPV/r; 91%), and atazanavir (ATV; 7%). After 3.3 (1.8–5.3) years on second-line ART, CD4 was 763 (556–1060) cells/mm3 and 26 (20–31)%. VF occurred in 73 (27%), with an incidence of 7.25 per 100 person-years (95% confidence interval [CI] 5.77–9.12). Resistance mutations in 50 of 73 children with available genotyping at first VF included M184V (56%), ≥1 thymidine analogue mutation (TAM; 40%), >4 TAMs (10%), Q151M (4%), any major LPV mutation (8%), >6 LPV mutations (2%), and any major ATV mutation (4%). Associations with VF included age >11 years (hazard ratio [HR] 4.06; 95%CI 2.15–7.66) and HIV-RNA >5.0 log10 copies/mL (HR 2.42; 95%CI 1.27–4.59) at switch, and was seen more commonly in children from Vietnam (HR 2.79; 95%CI 1.55 – 5.02). Conclusions One-fourth of children developed VF while on second-line ART. However, few developed major mutations to protease inhibitors.

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Section: Discussionmentioning

confidence: 99%

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Prasitsuebsai

Teeraananchai²,

Singtoroj

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…Effective antiretroviral therapy (ART) has increased the proportion of HIV-infected children surviving into adolescence (Chandwani et al, 2012; Garvie, Wilkins, & Young, 2010; Rongkavilit et al, 2007; UNAIDS, 2012). Adolescents face many challenges, including changes in body image, mindset and frequent peer pressure to engage risky behaviors.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling^†

Manaboriboon

Lolekha²,

Chokephaibulkit

et al. 2016

AIDS Care

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Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the “Youth Counseling Needs Survey” (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths’ psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010–July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11–18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths’ psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling.

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“…Although studies done to establish an association between adherence (measured by self report and medication return) and immunological response among paediatric HIV/AIDS patients have shown conflicting findings [12-14], adherence is a good predictor of effective virological suppression and subsequent immunological recovery. Some studies have shown and others have not shown an association between adherence by self report or medication return and immunological response.…”

Section: Introductionmentioning

confidence: 99%

Adherence to antiretroviral therapy among HIV infected children measured by caretaker report, medication return, and drug level in Dar Es Salaam, Tanzania

et al. 2013

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BackgroundAdherence to antiretroviral drugs in the treatment of paediatric HIV infection is complicated because of many factors including stigma and drug intake logistics. It is therefore important to identify children with non-adherence in order to intervene before they become at risk of developing treatment failure or drug resistance. The aim of this study was to determine the level of adherence to antiretroviral therapy (ART), measured by caretaker report, medication return and nevirapine plasma concentration. In addition, the association between level of adherence and patient’s immune status was compared across the three methods of measuring adherence.MethodsThis was a descriptive cross-sectional study involving HIV infected children aged 2–14 years, on nevirapine- based antiretroviral treatment for at least six months, attending care and treatment clinic in three municipal hospitals in Dar- Es- Salaam City. Eligible patients and their accompanying caretakers were consecutively enrolled after obtaining written informed consent. Structured questionnaires were administered to caretakers to assess patient’s adherence by caretaker report and medication return whereas a single blood sample for CD4 cell count/percent and determination of nevirapine plasma concentration was taken from patients on the day of assessment.ResultsA total of 300 patients and accompanying caretakers were enrolled and the mean patient age (SD) was 8 (3) years. Caretakers’ report and medication return showed good adherence (98% and 97%) respectively. However, the level of adherence assessed by nevirapine plasma concentration (85%) was significantly lower than caretaker report and medication return (p < 0.001). The agreement between nevirapine plasma concentration and medication return and between nevirapine plasma concentration and caretaker report was weak (k = 0. 131) (k = 0. 09) respectively. Nevirapine plasma concentration below 3 μg/ml was associated with immunosuppression (p = 0. 021) whereas medication return (>5% of prescribed doses) and caretaker reported missing more than one dose within 72 hours prior to interview were not associated with immunosuppression (p = 0. 474), (p = 0. 569) respectively.ConclusionLower adherence level observed using nevirapine plasma concentration and its association with immunological response supports the validity of the method and indicates that adherence data obtained from caretaker report and medication return may overestimate the true adherence in paediatric antiretroviral therapy.

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Medication Adherence in Adolescents With Behaviorally-acquired HIV: Evidence for Using a Multimethod Assessment Protocol

Cited by 32 publications

References 29 publications

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling^†

Adherence to antiretroviral therapy among HIV infected children measured by caretaker report, medication return, and drug level in Dar Es Salaam, Tanzania

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Medication Adherence in Adolescents With Behaviorally-acquired HIV: Evidence for Using a Multimethod Assessment Protocol

Cited by 32 publications

References 29 publications

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Treatment Outcomes and Resistance Patterns of Children and Adolescents on Second-Line Antiretroviral Therapy in Asia

Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling†

Adherence to antiretroviral therapy among HIV infected children measured by caretaker report, medication return, and drug level in Dar Es Salaam, Tanzania

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Product

Resources

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Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling^†