title: Patient, caregiver and regimen characteristics associated with adherence to highly active antiretroviral therapy among HIV-infected children and adolescents.
abstract: BACKGROUND
  This study assesses the relationship between child and caregiver perceptions of medication responsibility, disease knowledge, regimen complexity and adherence to highly active antiretroviral therapy among HIV-positive children. We also examine the association of adherence to child and caregiver demographic characteristics and surrogate markers of HIV disease.
  
  
  METHODS
  For this 6-month longitudinal study, 24 HIV-positive children (mean age = 14.0 years) being treated with highly active antiretroviral therapy and their caregivers completed measures of medication responsibility and disease knowledge. Medication Event Monitoring System caps calculated adherence across months 1 through 3 (time 1) and 4 through 6 (time 2).
  
  
  RESULTS
  Medication Event Monitoring System data revealed adherence rates of 81% at time 1 and 79% at time 2. Only 8% (n = 2) of child-caregiver pairs reported complete agreement regarding who held responsibility for medication-related tasks. Patients' responsibility for medication was correlated with age based on child (r = .51) and caregiver (r = .57; Ps < 0.05) perceptions, although their regimen knowledge was not. Greater regimen knowledge among caregivers and fewer child-caregiver discrepancies about medication responsibility predicted better adherence (adjusted R = .45). Finally, adherence was correlated with CD4 percentages at time 1 (r = .50) and viral load at time 1 (r = -.56) and time 2 (r= -.68; Ps < 0.05).
  
  
  CONCLUSIONS
  Medication adherence among HIV-infected children is lower than required for optimal viral suppression. Adherence is related to surrogate markers of HIV disease but not to child or caregiver demographic variables. Responsibilities for medication-related tasks should be clarified among family members, regimen knowledge should be emphasized and caregivers should avoid assigning treatment responsibility to a child prematurely.
authors.affiliation: HIV and AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA. martins@mail.nih.gov
authors.forename: Staci
authors.initials: S
authors.lastname: Martin
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Elliott-DeSorbo
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Wolters
authors.forename: Mary Anne
authors.initials: MA
authors.lastname: Toledo-Tamula
authors.forename: Gregg
authors.initials: G
authors.lastname: Roby
authors.forename: Steve
authors.initials: S
authors.lastname: Zeichner
authors.forename: Lauren V
authors.initials: LV
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D017028:Caregivers; D002648:Child; D004334:Drug Administration Schedule; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D010361:Patients