title: The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children.
abstract: BACKGROUND
  The toxicity and complexity of antiretroviral therapy (ART) regimens are substantial challenges in the context of patients' lives. This study examines child psychosocial and caregiver/family factors influencing adherence to ART in perinatally human immunodeficiency virus (HIV)-infected children.
  
  
  METHODS
  Seventy-five children (ages 3-13 years) prescribed ART, and their primary caregivers were recruited from 2 urban pediatric HIV programs. A battery of psychologic assessments and self-report adherence data were collected from all caregivers and 48 children who were > or =7 years old.
  
  
  RESULTS
  Forty percent of caregivers and 56% of children reported missed doses of medication in the past month. Families in which the caregiver or child reported missed doses (nonadherent) were compared with families who reported no missed doses (adherent). In univariate analyses, nonadherence was significantly associated with older child age (P < 0.05), worse parent-child communication (P < 0.017), higher caregiver stress (P < 0.002), lower caregiver quality of life (P < 0.003) and worse caregiver cognitive functioning (P = 0.033), and of borderline significance in its association with increased (1) child responsibility for medications (P < 0.07), (2) HIV disclosure to the child (P < 0.07) and (3) child stress (P < 0.08) In logistic regressions controlling for age, caregiver/family factors were the most strongly associated with nonadherence, including worse parent-child communication (P < 0.03), higher caregiver stress (P < 0.01), less disclosure to others (P < 0.05) and quality of life (P < 0.01).
  
  
  CONCLUSIONS
  Our data suggest that efforts to improve children's adherence to complex antiretroviral regimens requires addressing developmental, psychosocial and family factors.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, and Columbia University, College of Physicians and Surgeons, New York, NY, USA.
authors.forename: Claude Ann
authors.initials: CA
authors.lastname: Mellins
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Brackis-Cott
authors.forename: Curtis
authors.initials: C
authors.lastname: Dolezal
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010287:Parent-Child Relations; D010349:Patient Compliance; D011336:Probability; D011584:Psychology; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome