AIDS and Behavior

, Volume 19, Issue 4, pp 626–634 | Cite as

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

  • Rachel C. VreemanEmail author
  • Winstone M. Nyandiko
  • Hai Liu
  • Wanzhu Tu
  • Michael L. Scanlon
  • James E. Slaven
  • Samuel O. Ayaya
  • Thomas S. Inui
Original Paper


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.


Pediatric HIV care Adherence Best practice Resource-limited setting 



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.

Supplementary material

10461_2015_998_MOESM1_ESM.docx (188 kb)
Appendix 1 (DOCX 188 kb)


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Rachel C. Vreeman
    • 1
    • 2
    • 3
    Email author
  • Winstone M. Nyandiko
    • 2
    • 4
  • Hai Liu
    • 5
  • Wanzhu Tu
    • 5
  • Michael L. Scanlon
    • 1
    • 2
  • James E. Slaven
    • 5
  • Samuel O. Ayaya
    • 2
    • 4
  • Thomas S. Inui
    • 2
    • 3
    • 6
  1. 1.Children’s Health Services Research, Department of PediatricsIndiana University School of MedicineIndianapolisUSA
  2. 2.Academic Model Providing Access to Healthcare (AMPATH)EldoretKenya
  3. 3.Regenstrief Institute, Inc.IndianapolisUSA
  4. 4.Department of Child Health and PaediatricsMoi University School of MedicineEldoretKenya
  5. 5.Department of BiostatisticsIndiana University School of MedicineIndianapolisUSA
  6. 6.Department of MedicineIndiana University School of MedicineIndianapolisUSA

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