Antiretroviral adherence issues among HIV-positive adolescents and young adults

University of California, Los Angeles, Los Ángeles, California, United States
Journal of Adolescent Health (Impact Factor: 2.75). 11/1999; 25(5):316-9. DOI: 10.1016/S1054-139X(99)00052-X
Source: PubMed

ABSTRACT A total of 31 youth from a multidisciplinary adolescent human immunodeficiency virus clinic were surveyed to gain information about their adherence to complex antiretroviral regimens and elucidate factors that may be associated with adherence. Results indicated that 61% of subjects reported >90% compliance with their medications in the previous 90 days.

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    • "For example, among a large multicenter cohort of behaviorally infected youth, nonadherence to highly active antiretroviral therapy was correlated with low CD4 ϩ lymphocyte count and a high level of depression [19]. Having too many pills to take was the most commonly reported reason for missing medications among another sample of adolescents [20]. Other factors such as housing instability and/or length of treatment with antiviral medications (months of treatment) were significantly correlated with nonadherence [18] [21]. "
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    ABSTRACT: To compare prevalence and describe predictors of antiretroviral treatment adherence among adolescents with HIV acquired perinatally (PIY) or through risk behaviors (BIY). Data were obtained from the baseline assessment of Adolescent Impact, an intervention for HIV-infected adolescents receiving care in three U.S. cities. Patients self-reported missed medication doses as well as medication factors, HIV knowledge, disclosure, substance use, mental health, and social support through face-to-face or computer-assisted interviews. Of 104 participants, 68 (65.4%) reported full adherence. Compared with BIY, PIY were younger, had greater HIV disease severity, and had more structural supports. Adjusting for transmission mode (PIY vs. BIY), nonadherence by self-report was associated with higher viral load (VL) (adjusted odds ratio [AOR] = 1.5, confidence interval [CI] = 1.03, 2.18). Nonadherent adolescents were significantly likely to have had AIDS, discussed HIV disease with providers, reported difficulty with medication routine, experienced internalizing behavior problems, and used drugs. In multivariate analyses, independent predictors of nonadherence included acquiring HIV behaviorally (AOR = 4.378, CI = 1.055, 18.165), ever having AIDS (AOR = 4.78, CI = 1.31, 17.49), perceiving difficult medication routine (AOR = 1.84, CI = 1.07, 3.16), discussing disease indicators with provider (AOR = 4.57, CI = 1.74, 11.98), and missing doses because of forgetting (AOR = 2.53, CI = 1.29, 4.96). Adjusting for transmission mode, detectable VL was associated with lower recent CD4(+) lymphocyte counts, discussing disease indicators with providers, and missing doses because of forgetting or being depressed. Low recent CD4(+) lymphocyte counts (AOR = .988, p = .024) but fewer HIV symptoms (AOR = .466, p = .032) and missing doses because of forgetting (AOR = 1.76, p = .05) were independently associated with detectable VL in multivariate analysis. Despite differences between groups, nonadherence was associated with severity of illness, difficult medication routine, and forgetfulness. Beyond individual needs, both groups of adolescents had suboptimal adherence and would benefit from simplified medication routines and organizational skills.
    Journal of Adolescent Health 09/2012; 51(3):242-51. DOI:10.1016/j.jadohealth.2011.12.013 · 2.75 Impact Factor
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    • "In the few quantitative studies specifically focused on YLH, frequent substance use, advanced stage of HIV infection, younger age, life stressors (Murphy et al., 2005), psychological symptoms (Hosek, Harper, & Domanico, 2005; Naar-King et al., 2006; Williams et al., 2006), low self-efficacy (Naar-King et al., 2006), and perceptions of the effects of HIV medications (Belzer et al., 1999) have been linked to poor medication adherence. Conceptual models of adherence in YLH that are empirically tested are needed to understand the interrelationships among these factors. "
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    ABSTRACT: To test predictors of medication adherence in high-risk racial or ethnic minority youth living with HIV (YLH) using a conceptual model of social cognitive predictors including a continuous measure of motivational readiness. Youth were participants in a multi-site clinical trial examining the efficacy of a motivational intervention. Racial-minority YLH (primarily African American) who were prescribed antiretroviral medication were included (N = 104). Data were collected using computer-assisted personal interviewing method via an Internet-based application and questionnaires. Using path analysis with bootstrapping, most youth reported suboptimal adherence, which predicted higher viral load. Higher motivational readiness predicted optimal adherence, and higher social support predicted readiness. Decisional balance was indirectly related to adherence. The model provided a plausible framework for understanding adherence in this population. Culturally competent interventions focused on readiness and social support may be helpful for improving adherence in YLH.
    Journal of Pediatric Psychology 09/2009; 35(6):593-601. DOI:10.1093/jpepsy/jsp080 · 2.91 Impact Factor
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    • "Commonly cited factors associated with non-adherence include medication characteristics such as taste, size and side effects. Dosing characteristics that undermine adherence include the large pill burden (Belzer et al., 1999; Temple et al., 2001; Boni et al., 2000) and length of treatment (Martinez et al., 2000). Despite its importance in ensuring treatment success , pediatric adherence to daily drug regimens has not been widely assessed in Africa where over 90% of the children living with HIV are located (UNAIDS, 2004) Increased funding has greatly expanded access; for instance, in Uganda the number of children accessing ART has increased 10-fold in the past 2 years. "
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    ABSTRACT: Pediatric adherence to daily drug regimens has not been widely assessed in Africa where majority of HIV infected children live. Using in-depth interviews of 42 HIV-infected children taking ART and/or cotrimoxazole prophylaxis, and 42 primary caregivers, at a comprehensive HIV/AIDS clinic in Uganda, we evaluated their adherence experiences for purposes of program improvement. Daily drug regimens provided by the pediatric clinic included cotrimoxazole prophylaxis as well as ART and cotrimoxazole combined. Complete disclosure of HIV status by caregivers to children and strong parental relationships were related to good adherence. Structural factors including poverty and stigma were barriers to adherence even for children who had had complete disclosure and a supportive relationship with a parent. To ensure adherence to life-extending medications, our findings underscore the need for providers to support caregivers to disclose, provide on-going support and maintain open communication with HIV-infected children taking cotrimoxazole prophylaxis and ART.
    AIDS and Behavior 08/2006; 10(4 Suppl):S85-93. DOI:10.1007/s10461-006-9141-3 · 3.49 Impact Factor