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Adherence to medication regimens among children with human immunodeficiency virus infection
C Reddington1, J Cohen, A Baldillo
1Pediatric Spectrum of Disease Project, University of Massachusetts Medical School, Jamaica Plain, USA. Catherine.reddington@state.ma.us
Insights
Caregiver adherence to antiretroviral therapy in children with HIV is crucial for viral suppression. Interventions like better-tasting medications and improved access to medical advice can enhance adherence.
Area of Science:
- Pediatric Infectious Diseases
- HIV/AIDS Management
- Pharmacological Adherence Research
Background:
- Antiretroviral medication adherence is essential for maintaining undetectable viral loads in children with HIV.
- This study investigates adherence patterns and challenges faced by caregivers of HIV-infected children.
Purpose of the Study:
- To describe medication adherence in pediatric HIV patients.
- To explore caregiver experiences and opinions on HIV medication management.
- To identify potential interventions to improve adherence.
Main Methods:
- Interviews with caregivers of 90 HIV-infected children regarding medication administration.
- Assessment of medication-related issues and perceived usefulness of interventions.
- Correlation of adherence with HIV viral load and caregiver concerns.
Main Results:
- High rates of missed doses were reported; 43% missed at least one dose weekly.
- Adherent children were more likely to have undetectable viral loads (<400 copies/ml).
- Nonadherent caregivers expressed greater difficulty, sought more help, and had higher privacy concerns.
Conclusions:
- Caregiver perceptions of difficulty and privacy concerns impact adherence to complex antiretroviral regimens.
- Interventions focusing on medication palatability, convenience, and access to medical advice are highly desired.
- Improving medication convenience and palatability, alongside enhanced medical support, can significantly aid adherence.
Background:
Rigorous adherence to antiretroviral medication regimens is necessary to achieve and maintain undetectable viral levels. This study describes adherence in a population of children with HIV infection.
Methods:
Caregivers of HIV-infected children were interviewed about their experiences with administration of medications for treatment of HIV, opinions regarding medication-related issues and the potential usefulness of interventions to improve adherence.
Results:
In the 90 caregiver interviews completed, 78% of the children were taking 3 or more medications, 17% missed a dose in the previous 24 h and 43% missed at least 1 dose in the previous week. Children whose caregivers reported no missed doses in the previous week (adherent) were more likely to have an HIV viral load <400 copies/ml (50% vs. 24%, P = 0.04). Nonadherent caregivers (who reported 1 or more missed doses in the previous week) were more likely than adherent caregivers to agree with a statement that full adherence is impossible (44% vs. 12%, P = 0.001) and express the need for more help with medication administration (26% vs. 6%, P = 0.02). They were less likely to have informed the school or day-care site about the child's HIV infection (42% vs. 67%, P = 0.05) and more concerned about the child's teachers and friends finding out (54% vs. 31%, P = 0.05). Of 10 potential interventions 6 were rated by a majority of respondents as "very helpful": better tasting medications (81%); longer dosing intervals (72%); medications that did not require refrigeration (63%); access to 24-h telephone advice (62%); a follow-up call from a health care provider (57%); and a pill organizer (56%).
Conclusions:
Caregivers' perceptions that adherence is too difficult or concerns about loss of privacy may affect their ability to adhere to complicated medication regimens. Caregivers felt that the most helpful interventions would be modifications to improve the convenience and palatability of medications and increased access to medical advice.