title: Medication adherence in children and adolescents with HIV infection: associations with behavioral impairment.
abstract: The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000-2007). A total of 1134 participants, aged 3-17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p < 0.001), learning problems (22%, z = 12.2, p < 0.001), somatic complaints (22%, z = 12.6, p < 0.001), impulsivity-hyperactivity (20%, z = 11.1, p < 0.001), and hyperactivity (19%, z = 10.6, p < 0.001). Children with behavioral impairment in one or more areas had significantly increased odds of nonadherence [adjusted odds ratio (aOR) = 1.49, p = 0.04]. The odds of nonadherence were significantly higher for those with conduct problems and general hyperactivity (aOR = 2.03, p = 0.005 and aOR = 1.68, p = 0.02, respectively). Psychosocial and health factors, such as recent stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence.
authors.affiliation: Department of Child and Adolescent Psychiatry, Children's Memorial Hospital, Chicago, Illinois 60614, USA. kmalee@childrensmemorial.org
authors.forename: Kathleen
authors.initials: K
authors.lastname: Malee
authors.forename: Paige
authors.initials: P
authors.lastname: Williams
authors.forename: Grace
authors.initials: G
authors.lastname: Montepiedra
authors.forename: Marie
authors.initials: M
authors.lastname: McCabe
authors.forename: Sharon
authors.initials: S
authors.lastname: Nichols
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Sirois
authors.forename: Deborah
authors.initials: D
authors.lastname: Storm
authors.forename: John
authors.initials: J
authors.lastname: Farley
authors.forename: Betsy
authors.initials: B
authors.lastname: Kammerer
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002648:Child; D002653:Child Behavior Disorders; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents