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Comprehensive Evaluation of Caregiver-Reported Antiretroviral Therapy Adherence for HIV-Infected Children

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Abstract

For HIV-infected children, adherence to antiretroviral therapy (ART) is often assessed by caregiver report but there are few data on their validity. We conducted prospective evaluations with 191 children ages 0–14 years and their caregivers over 6 months in western Kenya to identify questionnaire items that best predicted adherence to ART. Medication Event Monitoring Systems® (MEMS, MWV/AARDEX Ltd., Switzerland) electronic dose monitors were used as external criterion for adherence. We employed a novel variable selection tool using the LASSO technique with logistic regression to identify items best correlated with dichotomized MEMS adherence (≥90 or <90 % doses taken). Nine of 48 adherence items were identified as the best predictors of adherence, including missed or late doses in the past 7 days, problems giving the child medicines, and caregiver-level factors like not being present at medication taking. These items could be included in adherence assessment tools for pediatric patients.

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Acknowledgments

We would first and foremost like to thank the Kenyan families who took part in this study. We would also like to acknowledge the significant work of key clinicians and nurses at AMPATH in promoting and helping evaluate adherence, including Irene Marete, Edith Apondi, Peter Gisore, Constance Tenge, Esther Nabakwe, John Chumba, Lucy Warui, Mary Rugut, Victor Cheboi, and Christine Mukhwana. This research was supported in part by a Grant (1K23MH087225) to Dr. Vreeman from the NIMH and AMPATH Plus with support from the United States Agency for International Development as part of the President’s Emergency Plan for AIDS Relief (PEPFAR).

Conflict of interest

The authors have no conflicts of interest to disclose.

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Authors and Affiliations

  1. Children’s Health Services Research, Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, HITS Suite 1000, Indianapolis, IN, 46202, USA

    Rachel C. Vreeman & Michael L. Scanlon

  2. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya

    Rachel C. Vreeman, Winstone M. Nyandiko, Michael L. Scanlon, Samuel O. Ayaya & Thomas S. Inui

  3. Regenstrief Institute, Inc., Indianapolis, IN, USA

    Rachel C. Vreeman & Thomas S. Inui

  4. Department of Child Health and Paediatrics, Moi University School of Medicine, Eldoret, Kenya

    Winstone M. Nyandiko & Samuel O. Ayaya

  5. Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA

    Hai Liu, Wanzhu Tu & James E. Slaven

  6. Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Thomas S. Inui

Authors
  1. Rachel C. Vreeman
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  2. Winstone M. Nyandiko
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  4. Wanzhu Tu
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  7. Samuel O. Ayaya
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Correspondence to Rachel C. Vreeman.

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Vreeman, R.C., Nyandiko, W.M., Liu, H. et al. Comprehensive Evaluation of Caregiver-Reported Antiretroviral Therapy Adherence for HIV-Infected Children. AIDS Behav 19, 626–634 (2015). https://doi.org/10.1007/s10461-015-0998-x

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  • DOI: https://doi.org/10.1007/s10461-015-0998-x

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