Published online May 28, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1371-e1383 (doi:10.1542/10.1542/peds.2006-1232)
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REVIEW ARTICLE

Adherence to Antiretroviral Therapy for Pediatric HIV Infection: A Qualitative Systematic Review With Recommendations for Research and Clinical Management

Jane M. Simoni, PhDa, Arianna Montgomery, MPHb, Erin Martin, MPHc, Michelle New, PhDd, Penelope A. Demas, PhDe and Sohail Rana, MD, FAAPf

a Department of Psychology, University of Washington, Seattle, Washington
b Center for HIV/AIDS/Viral Hepatitis/STD, and TB Prevention, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
c Departments of Special Immunology
d Psychology, Children's National Medical Center, Washington, DC
e AIDS Research Program, Montefiore Medical Center, Bronx, New York
f Department of Pediatrics and Child Health, Howard University, Washington, DC

Although nonadherence to prescribed therapies is widespread, it is particularly problematic with highly active antiretroviral therapy for HIV infection. This review of >50 studies in the area of pediatric HIV infection revealed varying methods for assessing antiretroviral adherence with a wide range of estimates of adherence. Correlates of adherence could be grouped as those relating to the medication, the patient, and the caregiver/family, with many conflicting findings and a lack of theory guiding the research. Only 8 studies, mainly small feasibility or pilot investigations, evaluated highly active antiretroviral therapy adherence interventions in pediatric populations. We conclude with specific recommendations for assessment and clinical management of adherence and discuss directions for future research in this area.

Key Words: HIV/AIDS • adherence • compliance • interventions • pediatric

Abbreviations: HAART—highly active antiretroviral therapy • VL—HIV-1 RNA viral load • DOT—directly observed therapy • EDM—electronic drug monitoring • GT—gastrostomy tube

Accepted Nov 21, 2006.


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