Antiretroviral adherence issues among HIV-positive adolescents and young adults
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.
- SourceAvailable from: Priya Lall
[Show abstract] [Hide abstract]
- "Publication (first author, year) Location (cities, country) Study populations Age (mean, range) Sample size (HIV-positive) Measurement of adherence to and/or retention in HIV care Method Intervention Main findings Belzer et al. 1999  Los Angeles, USA BIY 15Á24 31 Self-reported adherence Quantitative (survey) No Medication adherence most significantly correlates with stability of living conditions in BIY. Martinez et al. 2000  "
ABSTRACT: Introduction The 50% increase in HIV-related deaths in youth and adolescents (aged 10–24) from 2005 to 2012 highlights the need to improve HIV treatment and care in this population, including treatment adherence and retention. Youth and adolescents from key populations or young key populations (YKP) in particular are highly stigmatized and may face additional barrier(s) in adhering to HIV treatment and services. We reviewed the current knowledge on treatment adherence and retention in HIV care among YKP to identify gaps in the literature and suggest future directions to improve HIV care for YKP. Methods We conducted a comprehensive literature search for YKP and their adherence to antiretroviral therapy (ART) and retention in HIV care on PsycInfo (Ovid), PubMed and Google Scholar using combinations of the keywords HIV/AIDS, ART, adolescents, young adults, adherence (or compliance), retention, men who have sex with men, transgender, injection drug users, people who inject drugs and prisoners. We included empirical studies on key populations defined by WHO; included the terms youth and adolescents and/or aged between 10 and 24; examined adherence to or retention in HIV care; and published in English-language journals. All articles were coded using NVivo. Results and discussion The systematic search yielded 10 articles on YKP and 16 articles on behaviourally infected youth and adolescents from 1999 to 2014. We found no studies reporting on youth and adolescents identified as sex workers, transgender people and prisoners. From existing literature, adherence to ART was reported to be influenced by age, access to healthcare, the burden of multiple vulnerabilities, policy involving risk behaviours and mental health. A combination of two or more of these factors negatively impacted adherence to ART among YKP. Collectively, these studies demonstrated that future programmes need to be tailored specifically to YKP to ensure adherence. Conclusions There is an urgent need for more systematic research in YKP. Current limited evidence suggests that healthcare delivery should be tailored to the unique needs of YKP. Thus, research on YKP could be used to inform future interventions to improve access to treatment and management of co-morbidities related to HIV, to ease the transition from paediatric to adult care and to increase uptake of secondary prevention methods.Journal of the International AIDS Society 02/2015; 18(Suppl 1):19393. DOI:10.7448/IAS.18.2.19393 · 4.21 Impact Factor
[Show abstract] [Hide abstract]
- "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 . Having too many pills to take was the most commonly reported reason for missing medications among another sample of adolescents . Other factors such as housing instability and/or length of treatment with antiviral medications (months of treatment) were significantly correlated with nonadherence  . "
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
[Show abstract] [Hide abstract]
- "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. "
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