title: Family experiences with pediatric antiretroviral therapy: responsibilities, barriers, and strategies for remembering medications.
abstract: This study examines the relationship between adherence to pediatric HIV regimens and three family experience factors: (1) regimen responsibility; (2) barriers to adherence; and (3) strategies for remembering to give medications. Caregivers of 127 children ages 2-15 years in the PACTS-HOPE multisite study were interviewed. Seventy-six percent of caregivers reported that their children were adherent (taking > or = 90% of prescribed doses within the prior 6 months). Most caregivers reported taking primary responsibility for medication-related activities (72%-95% across activities); caregivers with primary responsibility for calling to obtain refills (95%) were more likely to have adherent children. More than half of caregivers reported experiencing one or more adherence barriers (59%). Caregivers who reported more barriers were also more likely to report having non-adherent children. Individual barriers associated with nonadherence included forgetting, changes in routine, being too busy, and child refusal. Most reported using one or more memory strategies (86%). Strategy use was not associated with adherence. Using more strategies was associated with a greater likelihood of reporting that forgetting was a barrier. For some families with adherence-related organizational or motivational difficulties, using numerous memory strategies may be insufficient for mastering adherence. More intensive interventions, such as home-based nurse-administered dosing, may be necessary.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University of the City of New York, New York, New York, USA. smarhefk@health.usf.edu
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Marhefka
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Koenig
authors.forename: Susannah
authors.initials: S
authors.lastname: Allison
authors.forename: Pamela
authors.initials: P
authors.lastname: Bachanas
authors.forename: Marc
authors.initials: M
authors.lastname: Bulterys
authors.forename: Linda
authors.initials: L
authors.lastname: Bettica
authors.forename: Vicki J
authors.initials: VJ
authors.lastname: Tepper
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D005190:Family; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D015497:HIV-1; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors