title: Association of antiretroviral and clinic adherence with orphan status among HIV-infected children in Western Kenya.
abstract: BACKGROUND
  Pediatric adherence to antiretroviral therapy (ART) is not well studied in resource-limited settings. Reported ART adherence may be influenced by contextual factors, such as orphan status.
  
  
  OBJECTIVE
  The objectives of this study were to describe self- and proxy-reported pediatric ART adherence in a resource-limited population and to investigate associated contextual factors.
  
  
  METHODS
  This was a retrospective study involving pediatric, HIV-infected patients in Western Kenya. We included patients aged 0-14 years, who were on ART and had at least 1 adherence measurement (N = 1516). We performed logistic regression to assess the association between orphan status and odds of imperfect adherence, adjusting for sex, age, clinic site, number of adherence measures, and ART duration, stratified by age and ART duration.
  
  
  RESULTS
  Of the 1516 children, only 33% had both parents living when they started ART. Twenty-one percent had only father dead, 28% had only mother dead, and 18% had both parents dead. Twenty-nine percent reported imperfect ART adherence. The odds of ART nonadherence increase for children with both parents dead. Fifty-seven percent of children had imperfect clinic adherence. There was no significant association between orphan status and imperfect clinic adherence.
  
  
  CONCLUSIONS
  The majority of pediatric patients in this resource-limited setting maintained perfect ART adherence, though only half kept all scheduled clinic appointments. Understanding contextual factors, such as orphan status, will strengthen adherence interventions.
authors.affiliation: Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, West 10th Street, Indianapolis, IN 46202, USA. rvreeman@iupui.edu
authors.forename: Rachel C
authors.initials: RC
authors.lastname: Vreeman
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Wiehe
authors.forename: Samwel O
authors.initials: SO
authors.lastname: Ayaya
authors.forename: Beverly S
authors.initials: BS
authors.lastname: Musick
authors.forename: Winstone M
authors.initials: WM
authors.lastname: Nyandiko