XVIII International AIDS Conference

Abstract

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Rates and 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

Background: 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 mortality.
Methods: 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.
Results: 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.


RegionNumber reviewedSample sizePercent adherentTotal number of participantsPercent adherent (weighted average)
Africa1442-151629-98%470579.6%
Asia229-16270-100%19174.4%
Australia118100%18100.0%
Europe1010-15021-93%75375.4%
Latin America and Caribbean454-19451-86%41267.0%
North America359-208831-97%677567.5%
Total669-208821-100%1285472.5%
[Proportion Adherent By Region]


Conclusions: In 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.


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