title: Factors influencing antiretroviral treatment suboptimal adherence among perinatally HIV-infected adolescents in Thailand.
abstract: BACKGROUND
  Existing studies have suggested decreased adherence and rebound in mortality in perinatally HIV-infected adolescents receiving antiretroviral therapy (ART) as compared to adults and young children.
  
  
  METHODS
  We used both quantitative and qualitative approaches to identify factors influencing adherence among perinatally infected adolescents in Thailand. We analyzed data from 568 pairs of perinatally infected adolescents (aged 12-19) and their primary caregivers in the Teens Living With Antiretrovirals (TEEWA) study, a cross-sectional survey conducted in 2010-2012. We also conducted 12 in-depth interviews in 2014 with infected adolescents or their primary caregivers to elicit experiences of living with long-term ART.
  
  
  RESULTS
  From the quantitative analysis, a total of 275 (48.4%) adolescents had evidence of suboptimal adherence based on this composite outcome: adolescents self-reported missing doses in the past 7 days, caregiver rating of overall adherence as suboptimal, or latest HIV-RNA viral load ≥1000 copies/ml. In multivariate logistic regression analysis, younger age, having grandparents or extended family members as the primary caregiver, caregiver-assessed poor intellectual ability, having a boy/girlfriend, frequent online chatting, self-reported unhappiness and easiness in asking doctors questions were significantly associated with suboptimal adherence. From the in-depth interviews, tensed relationships with caregivers, forgetfulness due to busy schedules, and fear of disclosing HIV status to others, especially boy/girlfriends, were important contributors to suboptimal adherence. Social and emotional support and counseling from peer group was consistently reported as a strong adherence-promoting factor.
  
  
  CONCLUSIONS
  Our findings highlight unique barriers of ART adherence among the perinatally infected adolescents. Future interventions should be targeted at helping adolescents to improve interpersonal relationships and build adaptive skills in recognizing and addressing challenging situations related to ART taking.
authors.affiliation: Harvard Medical School, Boston, United States of America.
authors.forename: Luyi
authors.identifier: http://orcid.org/0000-0002-2849-727X
authors.initials: L
authors.lastname: Xu
authors.affiliation: Harvard Medical School, Boston, United States of America.|Developmental Medicine Center, Division of Developmental Medicine, Boston Children's Hospital, Boston, United States of America.
authors.forename: Kerim
authors.initials: K
authors.lastname: Munir
authors.affiliation: Institut de recherche pour le développement (IRD) 174-PHPT, Chiang Mai, Thailand.|Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Cheeraya
authors.initials: C
authors.lastname: Kanabkaew
authors.affiliation: Institut de recherche pour le développement (IRD) 174-PHPT, Chiang Mai, Thailand.|Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand.|Institut National d'Etudes Démographiques (INED), Paris, France.|Harvard T.H. Chan School of Public Health, Boston, MA, United States of America.
authors.forename: Sophie
authors.initials: S
authors.lastname: Le Coeur
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018743:Perinatal Care; D011795:Surveys and Questionnaires; D013785:Thailand / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring