title: Usefulness of pharmacy dispensing records in the evaluation of adherence to antiretroviral therapy in Brazilian children and adolescents.
abstract: BACKGROUND
  Adherence, which is crucial to the success of antiretroviral therapy (HAART), is currently a major challenge in the care of children and adolescents living with HIV/AIDS.
  
  
  OBJECTIVE
  To evaluate the prevalence of nonadherence to HAART using complementary instruments in a cohort of children and adolescents with HIV/AIDS followed in a reference service in Campinas, Brazil.
  
  
  METHODS
  The level of adherence of 108 patients and caregivers was evaluated by an adapted standardized questionnaire and pharmacy dispensing records (PDR). Non-adherence was defined as a drug intake lower than 95% (on 24-hour or seven-day questionnaires), or as an interval of 38 days or more for pharmacy refills. The association between adherence and clinical, immunological, virological, and psychosocial characteristics was assessed by multivariate analysis.
  
  
  RESULTS
  Non-adherence prevalence varied from 11.1% (non-adherent in three instruments), 15.8% (24-hour self-report), 27.8% (seven-day self-report), 45.4% (PDR), and 56.3% (at least one of the outcomes). 24-hour and seven-day self-reports, when compared to PDR, showed low sensitivity (29% and 43%, respectively) but high specificity (95% and 85%, respectively). In multivariate analysis, medication intolerance, difficulty of administration by caregiver, HAART intake by the patient, lower socioeconomical class, lack of virological control, missed appointments in the past six months, and lack of religious practice by caregiver were significantly associated with non-adherence.
  
  
  CONCLUSIONS
  A high prevalence of HAART non-adherence was observed in the study population, and PDR was the most sensitive of the tested instruments. The instruments employed were complementary in the identification of non-adherence.
authors: Center for Investigation in Pediatrics, Graduate Program in Child and Adolescent Health, Medical School, Universidade Estadual de Campinas, São Paulo, Brazil.
authors: Aline Santarem
authors: AS
authors: Ernesto
authors: Renata Muller Banzato Pinto de
authors: RM
authors: Lemos
authors: Maria Ivone
authors: MI
authors: Huehara
authors: André Moreno
authors: AM
authors: Morcillo
authors: Maria Marluce
authors: MM
authors: Dos Santos Vilela
authors: Marcos Tadeu Nolasco da
authors: MT
authors: Silva
mesh_terms: D000293:Adolescent; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology / Q000706:statistics & numerical data*; D017028:Caregivers; D002648:Child; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010594:Pharmacies / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult; D016903:Drug Monitoring