title: Predictors of antiretroviral medication adherence among a diverse cohort of adolescents with HIV.
abstract: OBJECTIVE
  To compare prevalence and describe predictors of antiretroviral treatment adherence among adolescents with HIV acquired perinatally (PIY) or through risk behaviors (BIY).
  
  
  METHODS
  Data were obtained from the baseline assessment of Adolescent Impact, an intervention for HIV-infected adolescents receiving care in three U.S. cities. Patients self-reported missed medication doses as well as medication factors, HIV knowledge, disclosure, substance use, mental health, and social support through face-to-face or computer-assisted interviews.
  
  
  RESULTS
  Of 104 participants, 68 (65.4%) reported full adherence. Compared with BIY, PIY were younger, had greater HIV disease severity, and had more structural supports. Adjusting for transmission mode (PIY vs. BIY), nonadherence by self-report was associated with higher viral load (VL) (adjusted odds ratio [AOR] = 1.5, confidence interval [CI] = 1.03, 2.18). Nonadherent adolescents were significantly likely to have had AIDS, discussed HIV disease with providers, reported difficulty with medication routine, experienced internalizing behavior problems, and used drugs. In multivariate analyses, independent predictors of nonadherence included acquiring HIV behaviorally (AOR = 4.378, CI = 1.055, 18.165), ever having AIDS (AOR = 4.78, CI = 1.31, 17.49), perceiving difficult medication routine (AOR = 1.84, CI = 1.07, 3.16), discussing disease indicators with provider (AOR = 4.57, CI = 1.74, 11.98), and missing doses because of forgetting (AOR = 2.53, CI = 1.29, 4.96). Adjusting for transmission mode, detectable VL was associated with lower recent CD4(+) lymphocyte counts, discussing disease indicators with providers, and missing doses because of forgetting or being depressed. Low recent CD4(+) lymphocyte counts (AOR = .988, p = .024) but fewer HIV symptoms (AOR = .466, p = .032) and missing doses because of forgetting (AOR = 1.76, p = .05) were independently associated with detectable VL in multivariate analysis.
  
  
  CONCLUSIONS
  Despite differences between groups, nonadherence was associated with severity of illness, difficult medication routine, and forgetfulness. Beyond individual needs, both groups of adolescents had suboptimal adherence and would benefit from simplified medication routines and organizational skills.
authors.affiliation: Department of Pediatrics, New York University School of Medicine, New York, USA. sulachni.chandwani@nyumc.org
authors.forename: Sulachni
authors.initials: S
authors.lastname: Chandwani
authors.forename: Linda J
authors.initials: LJ
authors.lastname: Koenig
authors.forename: Anne M
authors.initials: AM
authors.lastname: Sill
authors.forename: Susan
authors.initials: S
authors.lastname: Abramowitz
authors.forename: Latoya C
authors.initials: LC
authors.lastname: Conner
authors.forename: Lawrence
authors.initials: L
authors.lastname: D'Angelo
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008603:Mental Health; D012650:Self Disclosure; D012944:Social Support; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology; D014481:United States / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents