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Barriers to Medication Adherence in Behaviorally and Perinatally Infected Youth Living with HIV

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The study explored barriers to antiretroviral medication adherence in perinatally and behaviorally HIV infected adolescents and young adults in a cross-sectional, multisite sample. The study included a subset of a convenience sample from a cross-sectional analysis. Participants were youth with HIV ages 12–24 who were prescribed HIV medication and reported missing medication in the past 7 days (n = 484, 28.4 % of protocol sample). The top barriers were similar for perinatally and behaviorally infected youth, but perinatally infected youth reported significantly more barriers. Forgetting, not feeling like taking medication and not wanting to be reminded of HIV infection were the most common barriers reported. Number of barriers was significantly correlated with percent of doses missed, viral load, and psychological distress for perinatally infected youth and with doses missed, psychological distress, and substance use for behaviorally infected youth. Interventions to improve adherence to HIV medications should not only address forgetfulness and choosing not to take medications, but also consider route of infection.

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  1. Joint United Nations Programme on HIV/AIDS. Report on the global AIDS epidemic. Mexico City, August: International AIDS Conference; 2008.

    Google Scholar 

  2. Arnett JJ. Emerging adulthood: the winding road from the late teens through the twenties. New York: Oxford University Press; 2004.

    Google Scholar 

  3. Simoni JM, Montgomery A, Martin E, New M, Demas PA, Rana S. Adherence to Antiretroviral Therapy for pediatric HIV infection: a qualitative systematic review with recommendations for research and clinical management. Pediatrics. 2007;119:e1371–83.

    Article  PubMed  Google Scholar 

  4. Hazra R, Siberry GK, Mofenson LM. Growing up with HIV: children, adolescents, and young adults with perinatally acquired HIV infection. Annu Rev Med. 2010;61:169–85.

    Article  PubMed  CAS  Google Scholar 

  5. Koenig LJ, Nesheim S, Abramowitz S. Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors. Curr Opin Obstet Gynecol. 2011;23(5):321–7.

    Article  PubMed  Google Scholar 

  6. Foster C, Fidler S. Adolescents with perinatally acquired HIV-1 Infection. Eur Infect Dis. 2011;5(1):10–6.

    Google Scholar 

  7. Rudy B, Murphy D, Harris R, Muenz L, Ellen J. Prevalence and interactions of patient-related risks for nonadherence to antiretroviral therapy among perinatally infected youth in the United States. AIDS Patient Care STDs. 2010;24(2):97–104.

    Article  PubMed  Google Scholar 

  8. Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15:1181–3.

    Article  PubMed  CAS  Google Scholar 

  9. Murphy DA, Sarr M, Durako SJ, Moscicki AB, Wilson CM, Muenz LR. Barriers to HAART adherence among Human Immunodeficiency Virus-infected adolescents. Arch Pediatr Adolesc Med. 2003;157:249–55.

    Article  PubMed  Google Scholar 

  10. MacDonell KE, Naar-King S, Murphy DA, Parsons JT, Huszti H. Situational temptation for HIV medication adherence in high-risk youth. AIDS Patient Care STDs. 2011;25(1):47–52.

    Article  PubMed  Google Scholar 

  11. Derogatis LR, Spencer PM. The brief symptom inventory (BSI): administration, and procedures manual-I. Baltimore, MD: Clinical Psychometric Research.

  12. Knight JR, Shrier LA, Bravender TJ, Farrell M, Vander Bilt J, Shafer HJ. A new brief screen for adolescent substance abuse. Arch Pediatr Adolesc Med. 1999;53:591–6.

    Google Scholar 

  13. Shiffman S, Stone AA, Hufford MR. Ecological momentary assessment. Ann Rev Clin Psychol. 2008;4:1–32.

    Article  Google Scholar 

  14. Woods PW, Moran LM, Carey CL, Dawson MS. ludicello JE, Gibson S, Grant I, Atkinson JH, the HIV Neurobehavioral Research Center (HNRC) Group. Prospective memory in HIV infection: Is “remembering to remember” a unique predictor of self-reported medication management? Arch Clin Neuropsychol. 2008;23(3):257–70.

    Google Scholar 

  15. Gonzalez JS, Penedo FJ, Llabre MM, Duran RE, Antoni MH, Schneiderman N, Horne R. Physical symptoms, beliefs about medications, negative mood, and long-term HIV medication adherence. Ann Behav Med. 2007;34(1):46–55.

    Article  PubMed  Google Scholar 

  16. Ammassari A, Murri R, Pezzotti P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV-infection. J Acquir Immune Defic Syndr. 2001;28:445–9.

    PubMed  CAS  Google Scholar 

  17. Roux P, Kouanfack C, Cohen J, Marcellin F, Boyer S, Delaporte E, Carrieri P, Laurent C, Spire B, the Stratall ANRS 12110/ESTHER Study Group. Adherence to antiretroviral treatment in HIV-positive patients in the Cameroon content: Promoting the use of medication reminder methods. J AIDS. 2011;57(6S):S40–S43.

    Google Scholar 

  18. Tanney MR, Naar-King S, MacDonell K. Depression and stigma in high-risk youth living with HIV: a multi-site study. J Pediatr Health Care (in press).

  19. Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDs. 2006;20(5):359–68.

    Article  PubMed  Google Scholar 

  20. Naar-King S, Kolmodin K, Parsons JT, Murphy DA. the ATN Protocol Team. Psychosocial factors and substance use in high risk youth living with HIV: a multisite study. AIDS Care. 2010;22(4):475–82.

    PubMed  Google Scholar 

  21. British HIV Association/Medical Society for the Study of Venereal Diseases (MSSVD). Guidelines on provision of adherence support to individuals receiving antiretroviral therapy. Accessed February 12, 2012; 2002.

  22. Stone A, Shiffman S. Ecological momentary assessment (EMA) in behavioral medicine. Ann Behav Med. 1994;16(3):199–202.

    Google Scholar 

  23. Haberer J, Kahane J, Kigozi I, Emenyonu N, Hunt P, Martin J, Bangsberg D. Real-time adherence monitoring for HIV antiretroviral therapy. AIDS Behav. 2010;14:1340–6.

    Article  PubMed  Google Scholar 

  24. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. October 14, 2011;1–167. Accessed February 21, 2012.

  25. Duncan LG, Moskowitz JT, Neilands TB, Dilworth SE, Hecht FM, Johnson MO. Mindfulness-based stress reduction for HIV treatment side effects: a randomized, wait-list controlled trial. J Pain Symptom Manage. 2012;43(2):161–71.

    Article  PubMed  Google Scholar 

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The Adolescent Trials Network for HIV/AIDS Interventions is funded by grants 5 U01 HD 40533 and 5 U01 HD 40474 from the National Institutes of Health through the National Institute of Child Health and Human Development (Bill Kapogiannis and Carol Worrell) with supplemental funding from the National Institute on Drug Abuse (Nicolette Borek), the National Institute of Mental Health (Andrew Forsyth and Pim Brouwers), and the National Institute on Alcohol Abuse and Alcoholism (Kendall Bryant). This research study was scientifically reviewed by the ATN’s Behavioral Leadership Groups. The authors acknowledge the ATN Coordinating Center at the University of Alabama at Birmingham, which is funded by grant U01 HD40533 (Craig Wilson and Cindy Partlow); the ATN Data and Operations Center at Westat, Inc. (Jim Korelitz and Barbara Driver) and Jacqueline Loeb, protocol specialist; the Community Advisory Board; and the subjects who participated in the study. The following ATN sites participated in this study: University of South Florida (Pat Emmanuel, Amayvis Rebolledo, and Tammy Myers), Children’s Hospital Los Angeles (Marvin Belzer, Diane Tucker, Nancy Flores, Julie McAvoy, and Michelle Bradford); Children’s National Medical Center (Larry D’Angelo and Connie Trexler), Children’s Hospital of Philadelphia (Steven Douglas, Mary Tanney, and Adrienne DiBenedetto), CORE Center/John H. Stroger Hospital (Jaime Martinez, Lisa Henry-Reid, Kelly Bojan, and Rachel Jackson), University of Puerto Rico (Irma Febo and Hazel Ayala), Montefiore Medical Center (Donna Futterman, Elizabeth Bruce, and Maria Campos), Mt. Sinai Medical Center (John Steever, Mary Geiger, and Jamie Kyei-Frimpong), University of California San Francisco (Barbara Moscicki and JB Molaghan), Tulane University (Sue Ellen Abdalian, Leslie Kozina, Alyne Baker, Brenda Andrews, and Trina Jeanjacques), University of Maryland Baltimore (Ligia Peralta, Reshma Gorle, and Leonel Flores), University of Miami (Larry Friedman, Donna Maturo, and Hanna Major-Wilson), Children’s Diagnostic and Treatment Center (Ana Puga, Esmine Downer, and Amy Inman), St. Jude Children’s Research Hospital (Pat Flynn, Mary Dillard, and Carla London), and Children’s Memorial Hospital (Rob Garofalo and Julia Brennan).

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Correspondence to Karen MacDonell.

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MacDonell, K., Naar-King, S., Huszti, H. et al. Barriers to Medication Adherence in Behaviorally and Perinatally Infected Youth Living with HIV. AIDS Behav 17, 86–93 (2013).

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