BACKGROUND: This study assesses the relationship between child and caregiver perceptions of medication responsibility, disease knowledge, regimen complexity and adherence to highly active antiretroviral therapy among HIV-positive children. We also examine the association of adherence to child and caregiver demographic characteristics and surrogate markers of HIV disease. METHODS: For this 6-month longitudinal study, 24 HIV-positive children (mean age = 14.0 years) being treated with highly active antiretroviral therapy and their caregivers completed measures of medication responsibility and disease knowledge. Medication Event Monitoring System caps calculated adherence across months 1 through 3 (time 1) and 4 through 6 (time 2). RESULTS: Medication Event Monitoring System data revealed adherence rates of 81% at time 1 and 79% at time 2. Only 8% (n = 2) of child-caregiver pairs reported complete agreement regarding who held responsibility for medication-related tasks. Patients' responsibility for medication was correlated with age based on child (r = .51) and caregiver (r = .57; Ps < 0.05) perceptions, although their regimen knowledge was not. Greater regimen knowledge among caregivers and fewer child-caregiver discrepancies about medication responsibility predicted better adherence (adjusted R = .45). Finally, adherence was correlated with CD4 percentages at time 1 (r = .50) and viral load at time 1 (r = -.56) and time 2 (r= -.68; Ps < 0.05). CONCLUSIONS: Medication adherence among HIV-infected children is lower than required for optimal viral suppression. Adherence is related to surrogate markers of HIV disease but not to child or caregiver demographic variables. Responsibilities for medication-related tasks should be clarified among family members, regimen knowledge should be emphasized and caregivers should avoid assigning treatment responsibility to a child prematurely.
BACKGROUND: This study assesses the relationship between child and caregiver perceptions of medication responsibility, disease knowledge, regimen complexity and adherence to highly active antiretroviral therapy among HIV-positive children. We also examine the association of adherence to child and caregiver demographic characteristics and surrogate markers of HIV disease. METHODS: For this 6-month longitudinal study, 24 HIV-positive children (mean age = 14.0 years) being treated with highly active antiretroviral therapy and their caregivers completed measures of medication responsibility and disease knowledge. Medication Event Monitoring System caps calculated adherence across months 1 through 3 (time 1) and 4 through 6 (time 2). RESULTS: Medication Event Monitoring System data revealed adherence rates of 81% at time 1 and 79% at time 2. Only 8% (n = 2) of child-caregiver pairs reported complete agreement regarding who held responsibility for medication-related tasks. Patients' responsibility for medication was correlated with age based on child (r = .51) and caregiver (r = .57; Ps < 0.05) perceptions, although their regimen knowledge was not. Greater regimen knowledge among caregivers and fewer child-caregiver discrepancies about medication responsibility predicted better adherence (adjusted R = .45). Finally, adherence was correlated with CD4 percentages at time 1 (r = .50) and viral load at time 1 (r = -.56) and time 2 (r= -.68; Ps < 0.05). CONCLUSIONS: Medication adherence among HIV-infectedchildren is lower than required for optimal viral suppression. Adherence is related to surrogate markers of HIV disease but not to child or caregiver demographic variables. Responsibilities for medication-related tasks should be clarified among family members, regimen knowledge should be emphasized and caregivers should avoid assigning treatment responsibility to a child prematurely.
Authors: Susannah M Allison; Linda J Koenig; Stephanie L Marhefka; Rosalind J Carter; Elaine J Abrams; Marc Bulterys; Vicki Tepper; Paul E Palumbo; Pamela J Bachanas; John J Farley Journal: J Assoc Nurses AIDS Care Date: 2010-05-07 Impact factor: 1.354
Authors: Patricia A Garvie; Sean S Brummel; Susannah M Allison; Kathleen M Malee; Claude A Mellins; Megan L Wilkins; Lynnette L Harris; E Doyle Patton; Miriam C Chernoff; Richard M Rutstein; Mary E Paul; Sharon L Nichols Journal: Pediatr Infect Dis J Date: 2017-08 Impact factor: 2.129
Authors: Neal S LeLeiko; Debra Lobato; Sarah Hagin; Elizabeth McQuaid; Ronald Seifer; Sheryl J Kopel; Julie Boergers; Jack Nassau; Kristina Suorsa; Jason Shapiro; Barbara Bancroft Journal: Inflamm Bowel Dis Date: 2013 Mar-Apr Impact factor: 5.325