A review of HIV antiretroviral adherence and intervention studies among HIV-infected youth.

Fenway Institute, Fenway Community Health, Boston, MA 02119, USA.
Topics in HIV medicine: a publication of the International AIDS Society, USA 17(1):14-25.
Source: PubMed

ABSTRACT Advances in antiretroviral medications have resulted in precipitous declines in HIV-associated morbidity and mortality; however, high levels of adherence are crucial to the success of HIV therapies. This article reviews published studies in the United States on HIV-infected youth (ages 13 to 24 years), focusing on adherence to antiretroviral regimens and interventions designed to enhance adherence. A systematic search yielded 21 articles published between 1999 and 2008 that reported data on medication adherence in HIV-infected youth, of which 7 described unique interventions to enhance medication adherence. Five thematic areas were identified to classify factors associated with adherence. Findings suggest psychosocial factors, in particular depression and anxiety, were consistently associated with poorer adherence across studies. Three types of adherence interventions with HIV-infected youth were found. Results suggest that examining adherence within the broader contextual issues present in the lives of youth, including HIV stigma and disclosure, caregiver stress, peer relations, mental health and substance use, and length of time on medications, may be most important to understanding how best to intervene with adherence among this population. Secondary HIV prevention interventions for youth represent a possible mode through which to deliver individually tailored adherence skill building and counseling to improve medication adherence.

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    ABSTRACT: Purpose: A number of potential determinants of medication non-adherence have been described so far. However, the heterogenic quality of existing publications poses the need for the use of a rigorous methodology in building a list of such determinants. The purpose of this study was a systematic review of current research on determinants of patient adherence on the basis of a recently agreed European consensus taxonomy and terminology. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Library, IPA, and PsycINFO were systematically searched for systematic reviews published between 2000/01/01 and 2009/12/31 that provided determinants on non-adherence to medication. The searches were limited to reviews having adherence to medication prescribed by health professionals for outpatient as a major topic. Results: Fifty-one reviews were included in this review, covering 19 different disease categories. In these reviews, exclusively assessing non-adherence to chronic therapies, 771 individual factor items were identified, of which most were determinants of implementation, and only 47—determinants of persistence with medication. Factors with an unambiguous effect on adherence were further grouped into 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 6 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and use of poor measurement methods resulted in many inconsistencies. Conclusions: This study provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore, the prediction of non-adherence of individual patients is difficult, and suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. The limited number of publications assessing determinants of persistence with medication, and lack of those providing determinants of adherence to short-term treatment identify areas for future research.
    Frontiers in Pharmacology 07/2013; 4:91. DOI:10.3389/fphar.2013.00091
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    Journal of HIV/AIDS & Social Services 01/2013; DOI:10.1080/15381501.2013.864177
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    ABSTRACT: Carol Bett is a faculty member at Wichita State University in Wichita, Kansas, where she teaches in the undergraduate nursing program. She writes about health challenges in rural Papua New Guinea and the efficacy of community health projects in developing countries. Carol has taught nursing students and worked in rural clinics in the highlands of Papua New Guinea. Demetrius Chapman is a public health clinical nurse specialist who has worked in urban and rural public health care settings and has served in various community health areas, including lead poisoning, adolescent parenting, and HIV/AIDS, as well as a satellite public health nursing office. His work with Native Americans living with HIV/AIDS exposed him to the difficulties they endure in trying to receive optimal care and prompted him to write the chapter about community-based health care for Diné people with HIV/AIDS. Barbara Cechanowicz has practiced in a variety of surgical settings as a mid-level provider. She has done medical mission work in Uganda and Zambia, has worked in a community health empowerment program in the inner city of Detroit with the Robert Wood Johnson Partnership for Training, and presently works in an Indian Health Service hospital. Barbara has a passion for delivering quality care to vulnerable populations and for translating today’s world of health care into the deeper dialogue of theory and philosophy. She writes about Navajo spiritual traditions and complex cultural phenomena. Stephen Hernandez is Assistant Professor at Northwestern State University, College of Nursing, in Shreveport, Louisiana, where he teaches undergraduate nursing students. His research interests include the factors that influence the decision of deployed armed A iv service members to seek needed mental health services. In his chapter, Stephen provides an exploration of the alarming prevalence of overweight and obese children in rural Louisiana. Hanna Krieger has been working in various capacities and in different specialty areas within nursing, nursing education, and advanced practice. Hanna does not subscribe to a specialty area in nursing; rather, she is particularly interested in the discipline of nursing itself. She is currently enrolled in the PhD program at the University of New Mexico and is writing her dissertation on clinically inflicted pain. In her chapter, Hanna discusses lesbian health and sexual orientation as a social determinant of health. Melanie Mayo was Director of Primary Care and Prevention Services at an urban Native American health clinic, worked in men’s and women’s prisons, was Associate Clinical Director at an inpatient hospice, and currently is a clinical practitioner in a long-term care setting. She writes about the economic and political dynamics associated with occupational and environmental exposure to uranium mining on New Mexico’s Colorado Plateau. Loyce Phoenix is a Commissioned Officer in the U.S. Public Health Service Corps and has worked most of her career in the Indian Health Service in a variety of administrative and clinical positions. Her most recent position is in public health nursing, and she is a Robert Wood Johnson Fellow with a study interest in Native American disparities. Loyce writes about violence against women on the Navajo reservation. Conrad Rios writes about nurse practitioners and physician assistants who provide health care in California's Rural Central Valley. Conrad is a family nurse practitioner and physician assistant whose area of interest is the care of the elderly. He wears multiple hats, including student, clinical faculty, and health care provider. He resides in Fresno, California. Teresa Sellstrom is Assistant Professor of Nursing at King College, Bristol, Tennessee, and teaches all levels of nursing students, including Master of Science in Nursing clinical nurse specialist students. Her background is in community health and maternal and acute adult health nursing. In her chapter, Teresa explores the use of telemedicine to improve rural health care. Max Veltman is Assistant Professor at Boise State University in the Department of Nursing. In addition to teaching, he works with the Idaho Health & Welfare Department on various projects dealing with the health care needs of children and adolescents in the foster care system. In his chapter, Max provides insight into the challenges of combating methamphetamine use and providing quality mental health services to improve the welfare of rural children. The challenges faced by local, national, and global communities in an ever-changing world have continued to grow as we complete the first decade of the 21st century. The doctoral students writing this book undertook the effort with advocacy for disenfranchised populations in mind. This compilation illuminates the challenges and gaps in access to health care confronted by a wide range of people, from overweight children, lesbians, and Native Americans to individuals in rural communities in Papua New Guinea. As the reader can readily see, we are a group of students with wide-ranging experiences and interests. Dr. Jennifer Averill