determinants of adherence to antiretroviral therapy (ART) in infants, children
and adolescents: a systematic review
Presented by Lisa Butler (United States).
L. Butler1,2, D. Bain Brickley3, J. Chan4, G. Kennedy3, G. Rutherford1,3
1University of California, Epidemiology and Biostatistics, San Francisco, United States, 2University of California, San Francisco, Global Health Sciences, San Francisco, United States, 3University of California, Global Health Sciences, San Francisco, United States, 4University of Toronto, Dalla Lana School of Public Health, Toronto, Canada
Achieving and maintaining high
levels of adherence to antiretroviral therapy (ART) in HIV-infected children is
necessary for improved growth and development and decreased morbidity and
To assess rates and determinants
of ART adherence among infants, children and adolescents, we
searched 9 electronic databases through September 2009 for published
observational studies reporting ART adherence rates/proportions among
individuals < 18 years. Data were abstracted in duplicate on adherence
outcomes, thresholds used to determine adherence, assessment method,
determinants of adherence and associations between adherence and viral load
and/or CD4 count/percent.
Sixty-six studies met the inclusion criteria.
Adherence assessment methods, time window for assessment, and thresholds for
determining adherence were inconsistent across studies. Where assessed, higher
level of ART adherence was consistently shown to be associated with viral load
suppression. Factors associated with
adherence included caregiver socio-demographic, cognitive, and psychosocial
characteristics; child health and psychosocial functioning;
treatment/medication characteristics; use of reminders; and structural factors.
Disclosure of HIV status to children was found to be associated with adherence
in some but not all studies where assessed.
[Proportion Adherent By Region]
|Region||Number reviewed||Sample size||Percent adherent||Total number of participants||Percent adherent (weighted average)|
|Latin America and Caribbean||4||54-194||51-86%||412||67.0%|
preparation for the global scaling-up of pediatric ART, there is an urgent need
for the development of reproducible measures of adherence in children, and for
testing strategies to improve adherence among children and adolescents.
Back to the session -
Back to the Programme-at-a-Glance