Assessing Medication Adherence in Adolescents with HIV When Electronic Monitoring Is Not Feasible

Wiener, Lori; Riekert, Kristin A.; Ryder, Celia; Wood, Lauren V.

doi:10.1089/1087291042223018

Cited by 17 publications

(31 citation statements)

References 35 publications

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“…Furthermore, some studies counted only doses taken on time as completed. 10 Assessment intervals (when reported) varied from 1 day to 1 year and were associated with adherence at least as assessed by clinic attendance.…”

Section: Estimates Of Adherence According To Assessment Methodsmentioning

confidence: 99%

“…10 Simple inquiries about whether the child took the morning dose of the medication and then tracing backward to the evening and the day before can be followed by how many doses could not be given in the previous week. This or a simple question about how many doses were missed in the previous week may be an appropriate starting point.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

“…This or a simple question about how many doses were missed in the previous week may be an appropriate starting point. 10,27,66,71 Questions regarding difficulties in administering medications such as child resistance or lack of disclosure of diagnosis to a temporary caregiver are useful as well. Providers should also elicit information regarding baby-sitting arrangements and methods used by the caregivers to remind others of the need for medication-taking.…”

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

“…Comparison between self-report and more objective measures and clinical indicators are needed to identify the most cost-effective assessment strategies. 10 In addition, more data on the pharmacokinetics and pharmacodynamics of pediatric formulations of HAART medications will make therapeutic drug monitoring a more reliable method of assessment.To investigate adherence levels and potential correlates of adherence, future research should incorporate prospective studies, perhaps beginning at HAART initiation and continuing throughout the disease course both in domestic and international settings. Steele and Grauer 20 advised systematically examining factors that may predict adherence and developing risk profiles to target potential nonadherers.…”

mentioning

confidence: 99%

“…The data on HAART for pediatric HIV infection, although scarcer than for adults, suggest that medication adherence is a strong predictor of therapeutic impact. 8,9 For example, Wiener et al 10 observed that among children with an HIV-1 RNA viral load (VL) < 10 000, 75% had taken 100% of their medication doses in the previous week, whereas among those with a VL of ≥10 000, only 36% reported taking all of their medication.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Adherence to Antiretroviral Therapy for Pediatric HIV Infection: A Qualitative Systematic Review With Recommendations for Research and Clinical Management

Simoni

Montgomery

Martin³

et al. 2007

Pediatrics

197

166

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Although nonadherence to prescribed therapies is widespread, it is particularly problematic with highly active antiretroviral therapy for HIV infection. This review of >50 studies in the area of pediatric HIV infection revealed varying methods for assessing antiretroviral adherence with a wide range of estimates of adherence. Correlates of adherence could be grouped as those relating to the medication, the patient, and the caregiver/family, with many conflicting findings and a lack of theory guiding the research. Only 8 studies, mainly small feasibility or pilot investigations, evaluated highly active antiretroviral therapy adherence interventions in pediatric populations. We conclude with specific recommendations for assessment and clinical management of adherence and discuss directions for future research in this area. KeywordsHIV/AIDS; adherence; compliance; interventions; pediatric Adherence to therapy, or the extent to which a patient's behaviors coincide with medical advice mutually negotiated between the health professional and the patient, is a universal HHS Public Access Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript challenge with all illnesses and in all age groups. 1 Each year in the United States, 500 000 physicians write 1.8 billion prescriptions involving 55 000 pharmacies. 2 However, many of these prescribed medications are never taken, with rates of nonadherence ranging from 15% to 93%. 3 Among persons with chronic illnesses, nonadherence is especially problematic, occurring in up to 82% of cases. [4][5][6] The effects of nonadherence range from individual disability (eg, unrelieved pain) to global threat (eg, development of treatment-resistant bacteria or viruses). The yearly monetary costs of nonadherence exceed $100 billion. 7Adherence is particularly critical with highly active antiretroviral therapy (HAART) in the treatment of pediatric HIV infection. The data on HAART for pediatric HIV infection, although scarcer than for adults, suggest that medication adherence is a strong predictor of therapeutic impact. 8,9 For example, Wiener et al 10 observed that among children with an HIV-1 RNA viral load (VL) < 10 000, 75% had taken 100% of their medication doses in the previous week, whereas among those with a VL of ≥10 000, only 36% reported taking all of their medication.Despite the benefits of HAART in treating pediatric HIV infection [11][12][13][14][15] and the adverse consequences of nonadherence, adherence is reportedly suboptimal among children. [16][17][18][19][20] It is likely thwarted by multiple barriers 21,22 and complicated because, unlike with many other chronic illnesses, most children who are born with HIV in the United States are ethnic/racial minorities who live in chronic poverty with limited resources and face discrimination, family disruption, substance abuse, and the stressors of life in the inner city. 23 In addition, stigma is greater for HIV/AIDS than other chronic illnesses, which often leads caregivers to conceal the child's diagnosis a...

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Section: Estimates Of Adherence According To Assessment Methodsmentioning

confidence: 99%

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

Section: Author Manuscript Author Manuscriptmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Adherence to Antiretroviral Therapy for Pediatric HIV Infection: A Qualitative Systematic Review With Recommendations for Research and Clinical Management

Simoni

Montgomery

Martin³

et al. 2007

Pediatrics

197

166

View full text Add to dashboard Cite

show abstract

Adherence and barriers to hyperinsufflation in children with congenital muscular dystrophy

Pascoe

Sawnani

Mayer

et al. 2016

Pediatric Pulmonology

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Virologic Response Using Directly Observed Therapy in Adolescents With HIV: An Adherence Tool

Purdy

Freeman²,

Martin³

et al. 2008

Journal of the Association of Nurses in AIDS Care

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Virologic response to highly active antiretroviral therapy (HAART) treatment of human immunodeficiency virus (HIV) infection depends on viral sensitivity to antiretrovirals (ARV's) and excellent medication adherence. Adolescents with vertically-acquired HIV may require complicated regimens due to significant treatment experience and often have poor medication adherence. A retrospective chart review identified five adolescents with vertically acquired HIV and plasma HIV viral load rebound or nonresponse on a stable HAART regimen followed by a period of directly observed therapy (DOT) in a clinic or hospital setting with serial viral load measurements. Four subjects had a virologic response (mean decline 1.15 log) after DOT. A response to HAART can be seen despite ARV resistance using DOT, and treatment-experienced patients seemingly unresponsive to HAART may be non-adherent even with reassuring adherence measures. A period of clinicmonitored DOT may allow diagnosis of non-adherence, discussion of medication barriers and avoidance of unnecessary medication changes. KeywordsHIV/AIDS; Directly Observed Therapy; adolescence; adherence; virologic response Highly active antiretroviral therapy (HAART) is remarkably effective in suppressing HIV replication, preventing opportunistic infections, and prolonging life in children and adults with HIV infection (Gortmaker et al., 2001;Palella et al., 1998). However, the success of HAART Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. (Watson & Farley, 1999). NIH Public AccessAdherence to medications is often difficult in the pediatric population for reasons generally related to the developmental stage of the patient. In younger children, poor medication tolerability and palatability, lack of available liquid formulations for some medications, and caregiver non-adherence hinder adherence.In the adolescent population, psychosocial factors contribute greatly to non-adherence to antiretrovirals (ARVs), and often adolescents are given independence in taking medications despite not fully understanding their regimens (Martin, Elliot, Toledo-Tamula, Wolters, & Wood, 2004;Murphy et al., 2003). However, data on adherence to ARVs in vertically-infected adolescents are limited. In a study by Van Dyke et al., 2002, almost one-third of 125 HIVinfected pediatric subjects, most of whom were not adolescents, reported non-adherence to ARVs over the course of one year. Only 41% of a group of 161 HIV-positive adolescents infected via sexual contact or drug injection reported full ARV adherence (Murphy et al., 2003).Although adolescents with behavi...

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Assessing Medication Adherence in Adolescents with HIV When Electronic Monitoring Is Not Feasible

Cited by 17 publications

References 35 publications

Adherence to Antiretroviral Therapy for Pediatric HIV Infection: A Qualitative Systematic Review With Recommendations for Research and Clinical Management

Adherence to Antiretroviral Therapy for Pediatric HIV Infection: A Qualitative Systematic Review With Recommendations for Research and Clinical Management

Adherence and barriers to hyperinsufflation in children with congenital muscular dystrophy

Virologic Response Using Directly Observed Therapy in Adolescents With HIV: An Adherence Tool

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