PEDIATRICS Vol. 118 No. 6 December 2006, pp. e1745-e1757 (doi:10.1542/10.1542/peds.2006-0493)
ARTICLE |
Predictors of Adherence to Antiretroviral Medications in Children and Adolescents With HIV Infection
a Center for Biostatistics in AIDS Research and the Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts
b François-Xavier Bagnoud Center, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
c Department of Neurosciences, University of California San Diego, La Jolla, California
d Departments of Psychiatry and Otolaryngology and Communication Disorders, Children's Hospital, Boston, Massachusetts
e Department of Pediatrics, Tulane University Health Sciences Center, New Orleans, Louisiana
f Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland
g Departments of Child and Adolescent Psychiatry and Infectious Diseases, Children's Memorial Hospital, Chicago, Illinois
BACKGROUND. Most evaluations of adherence to antiretroviral therapy in children with HIV infection have focused on validation of adherence measures via their association with virological outcomes. However, few studies have fully explored associations with other factors to guide development of adherence interventions.
METHODS. In this study, we examined the relationship of self-reported medication adherence to health, demographic, and psychosocial characteristics of children and their caregivers, using data from an ongoing multicenter prospective observational study of long-term outcomes of HIV infection conducted by the Pediatric AIDS Clinical Trials Group. Child and caregiver characteristics were evaluated for association with adherence via univariate and multiple logistic regression models.
RESULTS. Of the 2088 children and adolescents, 84% reported complete adherence to antiretroviral therapy medications over the past 3 days. The median viral load was 
10 times higher among nonadherent than adherent children, and the strength of this association increased with age. Factors associated with at least marginally significant increases in nonadherence in a multiple logistic regression model included increasing age in years, female gender, detectable HIV viral load, occurrence of recent stressful life events, repeating a grade in school, self-assessment of adherence by the subject, and diagnosis of depression or anxiety. Having an adult other than the biological parent as the primary caregiver, using a buddy system to remember to take antiretroviral therapy medications, higher caregiver education level, previous adherence assessments, and taking antipsychotic medications were each associated with improved adherence. After controlling for these characteristics, there was no significant association of adherence with race, knowledge of HIV status, medication burden, CD4 percentage, or current antiretroviral therapy.
CONCLUSIONS. Rates of self-reported adherence were relatively high and were influenced by multiple child and family characteristics. These findings identify targets for adherence interventions and highlight the importance of evaluating and supporting the family environment to optimize adherence.
Key Words: medication adherence • HIV • family environment • child behavior • adolescents • stressful life events
Abbreviations: ART—antiretroviral therapy • HAART—highly active antiretroviral therapy • REACH—Reaching Excellence in Adolescent Care and Health • PACTG—Pediatric AIDS Clinical Trials Group • NRTI—nucleoside reverse transcriptase inhibitor • PI—protease inhibitor • PCG—primary caregiver • CDC—Centers for Disease Control and Prevention • ADHD—attention-deficit/hyperactivity disorder • CI—confidence interval • OR—odds ratio
Accepted Jun 27, 2006.
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