Abstract

Rates and determinants of adherence to antiretroviral therapy (ART) in infants, children and adolescents: a systematic review

Presented by Lisa Butler (United States).

L. Butler^1,2, D. Bain Brickley³, J. Chan⁴, G. Kennedy³, G. Rutherford<sup>1,3

1</sup>University 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.

Region	Number reviewed	Sample size	Percent adherent	Total number of participants	Percent adherent (weighted average)
Africa	14	42-1516	29-98%	4705	79.6%
Asia	2	29-162	70-100%	191	74.4%
Australia	1	18	100%	18	100.0%
Europe	10	10-150	21-93%	753	75.4%
Latin America and Caribbean	4	54-194	51-86%	412	67.0%
North America	35	9-2088	31-97%	6775	67.5%
Total	66	9-2088	21-100%	12854	72.5%

[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.