title: Adherence to antiretroviral therapy of Brazilian HIV-infected children and their caregivers.
abstract: BACKGROUND
  Successful treatment of HIV-positive children requires a high level of adherence (at least 95%) to highly active antiretroviral therapy. Adherence is influenced by factors related to the child and caregivers.
  
  
  OBJECTIVE
  To evaluate children and caregivers characteristics associated to children's adherence.
  
  
  METHODS
  Cross-sectional study, from September 2013 to June 2015, comprising a sample of caregivers of perinatally HIV-infected children, in the age group of 1-12 years, under antiretroviral therapy for at least 6 months and on follow-up in two AIDS reference centers in Salvador, Bahia. Caregiver self-reports were the sole source of 4 days adherence and sociodemographic information. Study participants who reported an intake >95% of prescribed medication were considered adherents. A variable, ("Composed Adherence"), was created to better evaluate adherence.
  
  
  RESULTS
  We included 77 children and their caregivers. 88.3% of the caregivers were female, the median age was 38.0 years (IQR 33.5-47.5), 48.1% were white or mixed, 72.7% lived in Salvador and 53.2% had no fixed income. The 4 days child's adherence was associated only to caregivers that received less than a minimum salary (p<0.05), 70.1% of the caregivers had less than four years of formal education, 81.8% were children's relative and 53.2% of the caregivers were HIV positive. The caregiver's pharmacy refill, long-term adherence and 4 days adherence, were significantly associated with composed adherence (p<0.05). Child's long-term adherence was strongly associated to the 4 days child's adherence referred by caregiver (p<0.001).
  
  
  CONCLUSIONS
  Our results suggest the need of improvement in HIV-infected children adherence, through reinforcement of the caregivers own adherence.
authors.affiliation: Universidade Federal da Bahia (UFBA), Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brazil.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Ricci
authors.affiliation: Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina, Salvador, BA, Brazil.
authors.forename: Eduardo Martins
authors.initials: EM
authors.lastname: Netto
authors.affiliation: Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina, Salvador, BA, Brazil.
authors.forename: Estela
authors.initials: E
authors.lastname: Luz
authors.affiliation: Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP), Salvador, BA, Brazil.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rodamilans
authors.affiliation: Universidade Federal da Bahia (UFBA), Programa de Pós-Graduação em Medicina e Saúde, Salvador, BA, Brazil; Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Departamento de Medicina, Salvador, BA, Brazil. Electronic address: crbrites@ufba.br.
authors.forename: Carlos
authors.initials: C
authors.lastname: Brites
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D001938:Brazil; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D057566:Self Report; D012959:Socioeconomic Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Antiretroviral therapy; Caregivers; Children