title: Prevalence and interactions of patient-related risks for nonadherence to antiretroviral therapy among perinatally infected youth in the United States.
abstract: Adherence to antiretroviral regimens continues to be a significant problem in HIV-infected individuals facing a lifetime of therapy. Youth who were infected through perinatal transmission enter into adolescence often with a history of multiple medication regimens. Thus, adherence can be a particularly important issue in these young people, as medication options can often be limited. This was a cross-sectional, observational study to determine the prevalence of personal barriers to adherence and to identify associations among the following barriers in subjects 12 to 24 years old: mental health barriers, self-efficacy and outcome expectancy, and structural barriers. Among the 368 study participants, 274 (74.5%) were adherent and 94 (25.5%) were nonadherent to highly active antiretroviral therapy (HAART). No significant differences were found between adherent and nonadherent subjects according to mental health disorders. Adherence was associated with some but not all structural barriers. Both self-efficacy and outcome expectancy were significantly higher in adherent versus nonadherent subjects (p < 0.0001). In subjects with low self-efficacy and outcome expectancy, adherence differed according to the presence or absence of either mental health or structural barriers, similar to findings in behaviorally- infected adolescents. Interventions that address the breadth and clustering of adherence barriers in adolescents are needed to have the maximum chance for positive effects.
authors.affiliation: New York University School of Medicine, New York, New York, USA. Bret.rudy@nyumc.org
authors.forename: Bret J
authors.initials: BJ
authors.lastname: Rudy
authors.forename: Debra A
authors.initials: DA
authors.lastname: Murphy
authors.forename: D Robert
authors.initials: DR
authors.lastname: Harris
authors.forename: Larry
authors.initials: L
authors.lastname: Muenz
authors.forename: Jonathan
authors.initials: J
authors.lastname: Ellen
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology / Q000706:statistics & numerical data; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D018445:Infectious Disease Transmission, Vertical; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D020377:Self Efficacy; D055815:Young Adult