Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV

Abstract

This study identified factors associated with adherence to a 6-month isoniazid preventive therapy (IPT) course among adolescents and children living with HIV. Forty adolescents living with HIV and 48 primary caregivers of children living with HIV completed a Likert-based survey to measure respondent opinions regarding access to care, quality of care, preferred regimens, perceived stigma, and confidence in self-efficacy. Sociodemographic data were collected and adherence measured as the average of pill counts obtained while on IPT. The rates of suboptimal adherence (< 95% adherent) were 22.5% among adolescents and 37.5% among the children of primary caregivers. Univariate logistic regression was used to model the change in the odds of suboptimal adherence. Independent factors associated with suboptimal adherence among adolescents included age, education level, the cost of coming to clinic, stigma from community members, and two variables relating to self-efficacy. Among primary caregivers, child age, concerns about stigma, and location preference for meeting a community-health worker were associated with suboptimal adherence. To determine whether these combined factors contributed different information to the prediction of suboptimal adherence, a risk score containing these predictors was constructed for each group. The risk score had an AUC of 0.87 (95% CI: 0.76, 0.99) among adolescents and an AUC of 0.76 (95% CI: 0.62, 0.90), among primary caregivers suggesting that these variables may have complementary predictive utility. The heterogeneous scope and associations of these variables in different populations suggests that interventions aiming to increase optimal adherence will need to be tailored to specific populations and multifaceted in nature. Ideally interventions should address both long-established barriers to adherence such as cost of transportation to attend clinic and more nuanced psychosocial barriers such as perceived community stigma and confidence in self-efficacy.

Completion of isoniazid preventive therapy for latent tuberculosis infection among children and adolescents compared to adults living with HIV in Kinshasa, Democratic Republic of the Congo

“…There is limited published data on IPT completion in children/adolescents compared to adults [20], but some previous research in Sub-Saharan Africa has reported differences in IPT completion between children and adults [14,21]. In this analysis, the risk of non-completion was higher among children and adolescents than adults in unadjusted analysis; this finding partially supports our main hypothesis.…”

The Impact of Tuberculosis on the Well-Being of Adolescents and Young Adults

“…Notably, despite AYAs' increased risk of progression from TB infection to disease, most national TB programs do not prioritize this age group for tuberculosis preventive treatment (TPT), unless they are HIV-positive. Furthermore, even for HIV-positive AYAs, the degree of TPT uptake has seldom been reported [26].…”

Long-Term Real-World Effectiveness of Aripiprazole Once-Monthly. Treatment Persistence and Its Correlates in the Italian and Spanish Clinical Practice: A Pooled Analysis

“…Several investigators (especially in the past 5 years) have confirmed education (in addition to severity, occupational status and duration of condition) as a relevant predictor of treatment adherence and functioning in psychiatry ( 54 – 56 ). A relationship between “literacy” and adherence has also been reported in other situations where patients require chronic treatment (e.g., HIV, as reported in 57 , 58 ).…”