A review of HIV antiretroviral adherence and intervention studies among HIV infected Youth
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.
Available from: Karen (Kolmodin) MacDonell
- "Psychosocial factors, particularly 35 depression and anxiety, have been consistently associated with poor adherence to ART (Reisner et al., 2009). In addition, results suggest that adherence should be considered within the broader contextual issues present in the lives of youth, such as HIV stigma 40 and disclosure, peer relations, and mental health and substance use (Rao et al., 2012; Rao, Kekwaletswe, Hosek, Martinez, & Rodriguez, 2007; Reisner et al., 2009). Ethnic or racial minority status (Fogarty et al., 2002), lack of social support (MacDonell, Naar-King, 45 Murphy, Parsons, & Huszti, 2011), and low self-efficacy (Naar-King et al., 2006, 2013) have also been associated with poor medication adherence in youth living with HIV. "
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To test social cognitive predictors of medication adherence in racial/ethnic minority youth living with HIV using a conceptual model. METHODS: Youth were participants in two descriptive studies by the Adolescent Trials Network for HIV/AIDS Interventions. Minority youth ages 16-24 years who were prescribed antiretroviral medication were included (N = 956). Data were collected through chart extraction and/or laboratory testing and by Audio Computer-Assisted Self-Interview. RESULTS: 39% of youth reported suboptimal adherence. Path analysis was used to explore predictors of medication adherence. Higher self-efficacy predicted higher readiness and adherence. Greater social support predicted higher self-efficacy. Psychological symptoms and substance use were associated with several predictors and lower adherence. CONCLUSIONS: The model provided a plausible framework for understanding adherence in this population. Culturally competent, but individually tailored, interventions focused on increasing self-efficacy to take medication and reducing risk behaviors (e.g., substance use) may be helpful for racial or ethnic minority youth with HIV.
Available from: Elizabeth D Lowenthal
- "Although some studies have shown similar high rates of ART adherence among HIV-infected adolescents,6 a lower rate of adherence among HIV-infected adolescents has been reported more often,5–7,9 and expectations have been that adherence will diminish over time. In 2009, a review of studies on ART adherence and intervention among HIV-infected youths (13–24 years old) reported an overall rate of adherence ranging from 28.3% to 69.8%.6 The high proportion of HIV-infected adolescents with excellent pill count ART adherence and virologic suppression documented in our study is encouraging and demonstrates that excellent treatment outcomes can be achieved in HIV-infected adolescents in this setting. "
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ABSTRACT: Little is known about factors associated with suboptimal antiretroviral treatment (ART) adherence among adolescents in Sub-Saharan Africa. Our objective was to determine the level of ART adherence and predictors of non-adherence among human immunodeficiency virus (HIV)-infected adolescents at the Botswana-Baylor Children's Clinical Centre of Excellence in Gaborone, Botswana.
In a cross-sectional study, 82 HIV-infected adolescents receiving ART and their caregivers were administered a structured questionnaire. The patient's clinical information was retrieved from medical records. Outcome measures included excellent pill count ART adherence (>95%) and virologic suppression (HIV viral load <400 copies/mL). Multivariate logistic regression analysis was performed to identify independent predictors of ART non-adherence.
The overall median (interquartile range) ART adherence was 99% (96.5-100) (N = 82). Seventy-six percent of adolescents had excellent pill count ART adherence levels and 94% achieved virologic suppression. Male adolescents made up 65% of the non-adherent group (P = 0.02). Those who displayed suboptimal ART adherence were more likely to report having ever missed ART doses due to failure to pick up medication at the pharmacy (30.0% versus 9.7%, P = 0.03). In the multivariate logistic regression model, male sex (odds ratio [OR] 3.29, 95% confidence interval [CI] 1.13-9.54; P = 0.03) was the only factor which was independently associated with suboptimal ART adherence.
A high proportion of HIV-infected adolescents studied had excellent ART adherence and virologic suppression, with male adolescents at higher risk of suboptimal adherence than females. Further research to investigate how sex relates to suboptimal adherence may aid in the design of targeted intervention strategies.
Available from: Pawel Lewek
- "Lower affective pain ratings (Broekmans et al., 2009) Detectable viral load (in HIV-infected youth) (Reisner et al., 2009) Disease severity (Van Der Wal et al., 2005; DiMatteo et al., 2007; Reisner et al., 2009; Ruddy et al., 2009) Perceptions of disease severity (DiMatteo et al., 2007) More hospitalization (before starting ART in children) (Vreeman et al., 2008) Disease severity (Cramer, 2004; DiMatteo, 2004b; Chia et al., 2006; DiMatteo et al., 2007; Weiner et al., 2008; Julius et al., 2009; Lanouette et al., 2009) Worse clinical status (Fogarty et al., 2002) Possible consequences of missed doses (Cramer, 2004) "
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ABSTRACT: Purpose: A number of potential determinants of medication non-adherence has been described so far. However, heterogenic quality of existing publications poses the need for use of 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 grounds of 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 papers having adherence to medication prescribed by health professionals for outpatient as a major topic. Results: 51 papers were included in this review, covering 19 different disease categories. In these studies, 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 unambiguous effect on adherence were further grouped in 8 clusters of socio-economic-related factors, 6 of healthcare team- and system-related factors, 6 of condition-related factors, 7 of therapy-related factors, and 14 of patient-related factors. The lack of standardized definitions and poor measurement methods resulted in many inconsistencies. Conclusions: This research provides clear evidence that medication non-adherence is affected by multiple determinants. Therefore the prediction of non-adherence of individual patients is difficult. Consequently, suitable measurement and multifaceted interventions may be the most effective answer toward unsatisfactory adherence. 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.
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