Pediatric adherence to HIV antiretroviral therapy.

Massachusetts General Hospital Center for Global Health, Harvard Initiative for Global Health, 3rd floor, Cambridge, MA 02138, USA.
Current HIV/AIDS Reports 11/2009; 6(4):194-200. DOI: 10.1007/s11904-009-0026-8
Source: PubMed

ABSTRACT More than 2 million children are infected with HIV globally. Pediatric antiretroviral therapy (ART) adherence is complex, and current levels are often suboptimal. As established treatment programs in developed settings struggle with chronic therapy and nascent treatment programs in resource-limited settings expand, the importance and challenges of good adherence to ART are becoming ever more clear. Adherence behavior is influenced by many factors, which may be categorized as characteristics of the child, the caregiver(s) and family, the regimen, and society and culture. Many of these influences complicate measurement of pediatric adherence, and there is no gold standard. This article provides a conceptual framework and evidence-based look at the factors influencing ART adherence in children and aims to identify areas for intervention for this vulnerable population in need.

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    ABSTRACT: Advancements in therapy, including the use of highly active antiretroviral therapy, have increased survival and decreased opportunistic infections in HIV pediatric and adolescent population. Previous studies have found that in general HIV persons who maintained consistent ad had lower viral loads and improved health status. Nevertheless, adherence among children, adolescents, and youth has been found to be suboptimal. This systematic review describes interventions that have been conducted to improve adherence among these segments of the population diagnosed with HIV/AIDS, in both developed and developing settings. We found 16 interventions and clinical trials conducted between 2000 and 2011; these were grouped into studies that focused strictly on the medication (n = 6) and others that focused on factors associated with medication adherence (n = 10). The results indicate that, in 11 years, few treatment adherence interventions were conducted, most of which took place in the United States; although some articles reported more comprehensive interventions, all of them ultimately aimed only to promote adherence to antiretrovirals. We conclude that interventions need to be more specifically created for children and youth in order to improve adherence and promote self-care in general, incorporating the social determinants approach with special emphasis on the needs of children, adolescents, and youth according to their age. It is also concluded that interventions should be implemented and evaluated in contexts where children and youth are severely affected by HIV in regions like Africa, Latin America, and the Caribbean.
    Vulnerable Children and Youth Studies 12/2013; 8(4):321-337. DOI:10.1080/17450128.2013.764031
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    ABSTRACT: Background: Interrupting anti-retroviral therapy (ART) for any number of reasons is an indication of a compromised adherence to ART. Several factors, including the pill burden from other drugs used in treating co-infections in children with human immunodeficiency virus (HIV), may influence ART adherence. The aim of this study was to identify the factors associated with ART interruption in HIV-1-infected children. Materials and Methods: A retrospective cohort study analysing data on 580 children consecutively enrolled on ART between February 2006 and December 2010 at the paediatric HIV clinic of Jos University Teaching Hospital (JUTH), Jos. Subjects were children aged 2 months - 15 years diagnosed with HIV-1 infection and on first-line ART. Cotrimoxazole prophylaxis was usually commenced at diagnosis while awaiting ART commencement. Children diagnosed with tuberculosis (TB) were also placed on multiple individual anti-TB drugs. Statistical analysis used: A comparison of the data on children with and without ART interruption was made. Variables associated with ART interruption in a univariate analysis were fit in a multivariate logistic model to determine the factors that were associated with ART interruption. Results: Children on anti-TB drugs were twice more likely to interrupt ART compared to those who were not, (adjusted odds ratio, AOR = 1.84 (1.03-3.28); P = 0.04). But children on cotrimoxazole prophylaxis had a 57% reduction in the odds of interrupting ART compared to those who were not, (AOR = 0.43 (0.20-0.93); P = 0.03). Conclusion: Children on ART and also taking multiple individual anti-TB drugs should be monitored closely for ART adherence. Cotrimoxazole prophylaxis should be encouraged in children diagnosed with HIV while awaiting ART commencement as this may prime them for a better ART adherence. Keywords: ART interruption, anti-TB drugs, ART adherence, cotrimoxazole prophylaxis, HIV-1, Pill burden

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