Abstract
Accounting for 26% of all new HIV infections in the US each year, adolescents and young adults remain highly vulnerable to HIV. Current guidelines recommend starting antiretroviral therapy (ART) as soon as individuals are diagnosed with HIV, yet adherence to HIV medications remains suboptimal, especially among youth. Further, there are significant disparities in ART adherence across various sociodemographic groups with research indicating lower rates of adherence among racial/ethnic minorities, individuals from lower socioeconomic status, older adolescents, and female youth. Considering the detrimental consequences of untreated and/or poorly managed HIV, understanding factors that contribute to poor adherence among youth is critical. This chapter provides an overview of psychosocial, structural, and treatment-related barriers and facilitators to HIV medication adherence among children and adolescents/young adults with behaviorally or perinatally acquired HIV infection (BaHIV, PaHIV). Best practices for measuring adherence in youth, including self-report, pill counts and refills, electronic monitoring, and viral load/CD4 count, are reviewed as well as published adherence interventions in clinic and home/community settings, and interventions incorporating the use of technology. We also discuss the importance of considering multicultural factors in adherence interventions and provide suggested future directions for research and practice with pediatric populations.
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Annotated Bibliography
Berman, J. (2007). Tools for building culturally competent HIV prevention programs: With CD-ROM. Springer Publishing Company.
Berman’s book, informed by the scientific literature, discusses culture and cultural competence within the context of HIV risk and prevention. The book offers a comprehensive guide to help researchers and practitioners create, implement, and evaluate culturally competent and effective HIV prevention programs in their local communities.
Kahana, S., Rohan, J., Allison, S., Frazier, T., & Drotar, D. (2013). A meta-analysis of adherence to antiretroviral therapy and virologic responses in HIV-infected children, adolescents, and young adults. AIDS and Behavior, 17(1), 41–60. doi:10.1007/s10461-012-0159-4
This meta-analysis examined potential factors that influence the relationship between antiretroviral therapy adherence and clinical outcomes (i.e., viral load) among children, adolescents, and young adults living with HIV. Particularly informative is the study’s examination of a range of adherence measurement methodologies and their associations with clinical outcomes.
Reisner, M. S. L., Mimiaga, M. J., Skeer, M. M., Perkovich, M. B., Johnson, M. C. V., & Safren, S. A. (2009). A review of HIV antiretroviral adherence and intervention studies among HIV–infected youth. Topics in HIV Medicine, 17(1), 14–25.
Reisner and colleagues review all relevant US-based studies published between 1999 and 2008 focused on HIV medication adherence and interventions designed to increase adherence in youth living with HIV between the ages of 13–24. Findings highlighted the importance of broader contextual factors when studying adherence among youth.
Vreeman, R., Nyandiko, W., Liu, H., Tu, W., Scanlon, M., Slaven, J., et al. (2015). Comprehensive evaluation of caregiver-reported antiretroviral therapy adherence for HIV-infected children. AIDS and Behavior, 19(4), 626–634. doi:10.1007/s10461-015-0998-x
In this study, authors evaluated adherence rates and predictors of adherence among a large group of children (N = 191) aged 0–14 years and their caregivers over a 6 month time frame. Parent-report of adherence and parent-reported barriers to adherence were examined as well as their associations with an objective measure of ART adherence (i.e., Medication Event Monitoring System—MEMS).
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Thanks to the CHANGE Laboratory and Research Assistant Dominic Ingram for helping to conduct the literature reviews for this chapter.
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Thurston, I.B., Decker, K., Hardin, R. (2016). Antiretroviral Medication Adherence and Disease Management in Pediatric Populations. In: Chenneville, T. (eds) A Clinical Guide to Pediatric HIV. Springer, Cham. https://doi.org/10.1007/978-3-319-49704-4_7
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