The Role of Pharmacy Refill Measures in Assessing Adherence and Predicting HIV Disease Markers in Youth with Perinatally-Acquired HIV (PHIV)

  • Cenk Yildirim
  • Patricia A. Garvie
  • Miriam Chernoff
  • Megan L. Wilkins
  • E. Doyle Patton
  • Paige L. Williams
  • Sharon L. NicholsEmail author
  • for the Memory and Executive Functioning Study of the Pediatric HIV/AIDS Cohort Study
Original Paper


Antiretroviral (ARV) adherence is critical in monitoring disease response in youth with perinatally-acquired HIV (PHIV). We used pharmacy refill (PR) information for PHIV youth from the PHACS Memory Sub-study to calculate medication availability over 2, 4, and 6 months. PR, a proxy of adherence, was compared with self-reported 7-day adherence in predicting suppressed viral load (SVL < 400 copies/mL) and higher CD4% (≥ 25%). Among 159 PHIV youth, 79% were adherent by 7-day recall, and 62, 55, and 48% by PR over 2, 4, and 6 months, respectively. Agreement between 7-day recall and PR adherence was weak (Kappa = 0.09–0.25). In adjusted logistic regression models, adherence showed associations with SVL for 7-day recall (OR 2.78, 95% CI 1.08, 7.15) and all PR coverage periods (6-month: OR 3.24, 95% CI 1.22, 8.65). Similar associations were observed with higher CD4%. PR measures were predictive of study retention. Findings suggest a possibly independent role of PR adherence measures.


ARV adherence Pediatric HIV Pharmacy refill Self-report Appointment adherence 



The authors extend their gratitude to Kunjal Patel, DSc, MPH, Senior Research Scientist, Harvard T.H. Chan School of Public Health, Department of Epidemiology, for her valuable consultation to the statistical analyses.


The Pediatric HIV/AIDS Cohort Study (PHACS) Memory and Executive Functioning substudy was supported by the National Institute of Mental Health (MH084794; PI: Sharon Nichols). Data analysis services were provided by the Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health (PI: Paige Williams); data management services were provided by Frontier Science and Technology Research Foundation (PI: Suzanne Siminski); and regulatory services and logistical support were provided by Westat, Inc. (PI: Julie Davidson). The Pediatric HIV/AIDS Cohort Study (PHACS) was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development with co-funding from the National Institute on Drug Abuse, the National Institute of Allergy and Infectious Diseases, the Office of AIDS Research, the National Institute of Mental Health, the National Institute of Neurological Disorders and Stroke, the National Institute on Deafness and Other Communication Disorders, the National Heart Lung and Blood Institute, the National Institute of Dental and Craniofacial Research, and the National Institute on Alcohol Abuse and Alcoholism, through cooperative agreements with the Harvard University T.H. Chan School of Public Health (HD052102) (Principal Investigator: George Seage; Project Director: Julie Alperen) and the Tulane University School of Medicine (HD052104) (Principal Investigator: Russell Van Dyke; Co-Principal Investigators: Kenneth Rich, Ellen Chadwick; Project Director: Patrick Davis).

We thank the children and families for their participation in the Memory/EF Sub-study and PHACS and the individuals and institutions involved in the conduct of these studies. The following institutions, clinical site investigators and staff participated in conducting PHACS AMP; sites participating in the Memory Study and the site PI are marked with an asterisk. In alphabetical order: Ann & Robert H. Lurie Children’s Hospital of Chicago*: Ram Yogev, Margaret Ann Sanders, Kathleen Malee*, Scott Hunter; Baylor College of Medicine*: William Shearer, Mary Paul, Norma Cooper, Lynnette Harris*; Bronx Lebanon Hospital Center: Murli Purswani, Mahboobullah Baig, Anna Cintron; Children’s Diagnostic & Treatment Center*: Ana Puga, Sandra Navarro, Patricia Garvie*, James Blood; Children’s Hospital, Boston*: Sandra Burchett, Nancy Karthas, Betsy Kammerer*; Jacobi Medical Center*: Andrew Wiznia, Marlene Burey, Molly Nozyce*; Rutgers - New Jersey Medical School: Arry Dieudonne, Linda Bettica, Susan Adubato; St. Christopher’s Hospital for Children: Janet Chen, Maria Garcia Bulkley, Latreaca Ivey, Mitzie Grant; St. Jude Children’s Research Hospital*: Katherine Knapp, Kim Allison, Megan Wilkins*; San Juan Hospital/Department of Pediatrics: Midnela Acevedo-Flores, Heida Rios, Vivian Olivera; Tulane University Health Sciences Center*: Margarita Silio, Medea Jones, Patricia Sirois*; University of California, San Diego*: Stephen Spector, Kim Norris, Sharon Nichols*; University of Colorado Denver Health Sciences Center: Elizabeth McFarland, Alisa Katai, Jennifer Dunn, Suzanne Paul; University of Miami: Gwendolyn Scott, Patricia Bryan, Elizabeth Willen

Note: The conclusions and opinions expressed in this article are those of the authors and do not necessarily reflect those of the National Institutes of Health or the U.S. Department of Health and Human Services.

Compliance with Ethical Standards

Conflict of interest

All authors declare that they have no conflicts of interest to report.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Cenk Yildirim
    • 1
  • Patricia A. Garvie
    • 2
  • Miriam Chernoff
    • 1
  • Megan L. Wilkins
    • 3
  • E. Doyle Patton
    • 4
  • Paige L. Williams
    • 1
    • 5
  • Sharon L. Nichols
    • 6
    Email author
  • for the Memory and Executive Functioning Study of the Pediatric HIV/AIDS Cohort Study
  1. 1.Center for Biostatistics in AIDS ResearchHarvard T. H. Chan School of Public HealthBostonUSA
  2. 2.Research DepartmentChildren’s Diagnostic & Treatment CenterFort LauderdaleUSA
  3. 3.St. Jude Children’s Research HospitalMemphisUSA
  4. 4.Patton Psychology Associates, Inc.AventuraUSA
  5. 5.Departments of Biostatistics and EpidemiologyHarvard T. H. Chan School of Public HealthBostonUSA
  6. 6.Department of NeurosciencesUniversity of California, San DiegoLa JollaUSA

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