Predictors and Evolution of Antiretroviral Therapy Adherence Among Perinatally HIV-Infected Adolescents in Brazil.
Antiretroviral therapy medication adherence is a complex phenomenon influenced by multiple factors. This study examines its evolution and predictors among perinatally HIV-infected youths in São Paulo, Brazil.



During a 1-year longitudinal cohort study, perinatally HIV-infected youths aged 13-21 years taking antiretroviral therapy were recruited in hospitals and HIV/AIDS reference centers. Data were collected at baseline and after 12 months. Variables assessed were adherence, self-efficacy regarding medication intake, social support, stress level, depression, CD4 cell count, viral load, and symptoms. Adherence was defined as taking ≥95% of prescribed HIV medication in the past 7 days. Generalized estimating equation and analysis of variance methods were used.



A total of 268 adolescents participated in the study (59% female; mean age of 16 years). At baseline, 63.06% of the sample was adherent to their HIV medication, and 52.99% had an undetectable viral load. All participants, regardless of adherence, reported: low levels of stress and symptoms of depression; high perception of medication self-efficacy and social support; and a mean of 6.8 symptoms related to their HIV medication. Predictors of adherence were: high perception of medication self-efficacy (odds ratio = 2.81; 95% confidence interval: 1.94-4.05) and low number of reported medication side effects (odds ratio = .97; 95% confidence interval: .95-.99]. Between baseline and follow-up, 49.6% remained adherent, 22.3% remained nonadherent, and the adherence level changed over time for 28.2%.



These findings suggest the need to develop interventions to enhance self-efficacy toward medication and to help youth better manage HIV medication symptoms.
Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Research Chair in Innovative Nursing Practices, Montreal, Quebec, Canada; Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada. Electronic address: jose.cote@umontreal.ca.
José
J
Côté
La Source, School of Nursing, University of Applied Sciences, Lausanne, Switzerland.
Philippe
P
Delmas
Escola Paulista de Medicina, Universidade Federal De São Paulo (UNIFESP), São Paulo, Brazil.
Regina Célia
RC
de Menezes Succi
Centro de Referencia e Treinamento DST/Aids-Programa Estadual de São Paulo, São Paulo, Brazil.
Eliana
E
Galano
Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Research Chair in Innovative Nursing Practices, Montreal, Quebec, Canada.
Patricia
P
Auger
Department of Nursing, Université du Québec à Rimouski, Rimouski, Quebec, Canada.
Hélène
H
Sylvain
Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada.
Sebastien
S
Colson
Escola Paulista de Medicina, Universidade Federal De São Paulo (UNIFESP), São Paulo, Brazil.
Daisy Maria
DM
Machado
D000293:Adolescent; D000704:Analysis of Variance; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001938:Brazil; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D003863:Depression / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology / Q000635:transmission; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D020377:Self Efficacy; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D019562:Viral Load / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
D019380:Anti-HIV Agents
Adolescents; Depression; HIV; HIV medication; Medication adherence; Perinatally HIV-infected adolescents; Self-efficacy; Side effects; Social support; Stress