Medication adherence in children and adolescents with HIV infection: associations with behavioral impairment
Kathleen Malee, Paige Williams, Grace Montepiedra, Marie McCabe, Sharon Nichols, Patricia A Sirois, Deborah Storm, John Farley, Betsy Kammerer, PACTG 219C Team, Mary Culnane, Elizabeth Hawkins, Lynne Mofenson, Yvonne J Bryson, Edward M Connor, Lawrence D'Angelo, Mark Mintz, Karen J O'Donnell, Margaret Oxtoby, Andrea Rubin Hale, Richard D Gelber, Steven Gortmaker, William Lenderking, Lynn Marrow, Christina Joy, Colleen Clark, Bethann Cunningham, Rhoda Sperling, Gwendolyn B Scott, Courtney Fletcher, Blake Caldwell, Dianne Donovan, Elizabeth Smith, Anne Fresia, Gregory Ciupak, Carol Elgie, Michelle Eagle, Dorothy R Smith, Paul Palumbo, John Sleasman, James Connor, Michael Hughes, Rebecca Oyomopita, George Johnson, Andrew Wiznia, Nancy Hutton, Andrea Kovacs, Mary Sawyer, Martin Anderson, Audrey Rogers, William Borkowsky, Jane Lindsey, Jack Moye, Myron Levin, Marilyn Crain, Paul Britto, Ruth Toumala, Joseph Cervia, Eileen Monagham, Kenneth Dominguez, Melody Higgins, George Seage, Denise Gaughan, Phil Gona, William Shearer, Lois Howland, Deborah Storm, Kathleen Malee, Wendy Mitchell, Carol Gore, Eve Powell, Michelle McConnell, Newana Beatty, Susan Brogly, Jennifer Bryant, Miriam Chernoff, Barbara Heckman, Dawn English, Edward Handelsman, Patrick Jean-Philippe, Kathleen Kaiser, Joyce Kraimer, Linda Millar, Shirley Traite, Paige Williams, Elizabeth Woods, Carol Worrell, F Minglana, M E Paul, C D Jackson, M H Rathore, A Khayat, K Champion, S Cusic, R Yogev, E Chadwick, I Febo-Rodriguez, S Nieves, M Purswani, S Baksi, E Stuard, M Dummit, M Acevedo, M Gonzalez, L Fabregas, M E Texidor, G B Scott, C D Mitchell, L Taybo, S Willumsen, L Bettica, J Amour, B Dashefsky, J Oleske, M Silio, T Alchediak, C Borne, M Cowie, S A Spector, R Viani, M Caffery, L Proctor, S Rana, D Darbari, J C Roa, P H Yu, M Donovan, R Serrano, M Burey, R Auguste, J Chen, J Foster, B W Stechenberg, D J Fisher, A M Johnston, M Toye, J Homans, M Neely, L S Spencer, A Kovacs, S Burchett, N Karthas, E Moore, C Cromer, P M Flynn, N Patel, M Donohoe, S Jones, W Borkowsky, S Chandwani, N Deygoo, S Akleh, E Handelsman, H J Moallem, D M Swindell, J M Kaye, A Higgins, M Foca, P LaRussa, A Gershon, R M Rutstein, C A Vincent, S D Douglas, G A Koutsoubis, A Petru, T Courville, D Wara, D Trevithick, E McFarland, C Salbenblatt, N Hutton, B Griffith, M Joyner, C Kiefner, M Acker, R Croteau, C McLellan, K Mohan, M Bamji, I Pathak, S Manwani, E Patel, H Spiegel, V Amos, K Luzuriaga, R Pass, M Crain, J Farley, K Klipner, V R Bonagura, S J Schuval, C Colter, L Campbell, S I Pelton, A M Reagan, K C Rich, K Hayani, M Bicchinella, S Nachman, D Ferraro, S Madjar, A Puga, F Wiley, K Whitfield, O Johnson, R Dizney, S Champion, M Frere, M DiGrado, E J Abrams, J Martinez, M Mancao, J Salazar, G Karas, T Belho, B Pitkin, J Eddleman, W Figueroa, E Reyes, L B Weiner, K A Contello, W A Holz, M J Famiglietti, R Lawrence, J Lew, C Delany, C Duff, A D Fernandez, P A Hughes, N Wade, M E Adams, J P Piatt, J Foti, L Clarke-Steffen, J Sleasman, C Delaney, C S Mani, W A Andiman, S Romano, L Hurst, J de Jesus, G Wilson, G A Weinberg, F Gigliotti, B Murante, S Laverty, N Hutchcon, A Townley, S Nesheim, R Dennis, P Emmanuel, J Lujan-Zilberman, C Graisberry, S Moore, R G Fisher, K M Cunnion, T T Rubio, D Sandifer, G M Johnson, H Gay, S Sadler, M Keller, J Hayes, A Gagajena, C Mink, D Johnson, J Church, T Dunaway, C Salata, A Deveikis, L Melton, S Gaur, P Whitley-Williams, A Malhotra, L Cerracchio, M Dolan, J D'Agostino, R Posada, C Mani, S Cobb, S R Lavoie, T Y Smith, A Feingold, S Burrows-Clark, J Mrus, R Beiting, M Brady, J Hunkler, K Koranyi, W Albritton, R Warford, S Arpadi, A Gershon, P Miller, A Rubinstein, G Krienik, A Kovacs, E Operskalski, D Wara, A Kamrin, S Farrales, R Johan-Liang, K O'Keefe, K A McGann, L Pickering, G A Storch, S Pahwa, L Rodriquez, P Lewis, R Croteau, Kathleen Malee, Paige Williams, Grace Montepiedra, Marie McCabe, Sharon Nichols, Patricia A Sirois, Deborah Storm, John Farley, Betsy Kammerer, PACTG 219C Team, Mary Culnane, Elizabeth Hawkins, Lynne Mofenson, Yvonne J Bryson, Edward M Connor, Lawrence D'Angelo, Mark Mintz, Karen J O'Donnell, Margaret Oxtoby, Andrea Rubin Hale, Richard D Gelber, Steven Gortmaker, William Lenderking, Lynn Marrow, Christina Joy, Colleen Clark, Bethann Cunningham, Rhoda Sperling, Gwendolyn B Scott, Courtney Fletcher, Blake Caldwell, Dianne Donovan, Elizabeth Smith, Anne Fresia, Gregory Ciupak, Carol Elgie, Michelle Eagle, Dorothy R Smith, Paul Palumbo, John Sleasman, James Connor, Michael Hughes, Rebecca Oyomopita, George Johnson, Andrew Wiznia, Nancy Hutton, Andrea Kovacs, Mary Sawyer, Martin Anderson, Audrey Rogers, William Borkowsky, Jane Lindsey, Jack Moye, Myron Levin, Marilyn Crain, Paul Britto, Ruth Toumala, Joseph Cervia, Eileen Monagham, Kenneth Dominguez, Melody Higgins, George Seage, Denise Gaughan, Phil Gona, William Shearer, Lois Howland, Deborah Storm, Kathleen Malee, Wendy Mitchell, Carol Gore, Eve Powell, Michelle McConnell, Newana Beatty, Susan Brogly, Jennifer Bryant, Miriam Chernoff, Barbara Heckman, Dawn English, Edward Handelsman, Patrick Jean-Philippe, Kathleen Kaiser, Joyce Kraimer, Linda Millar, Shirley Traite, Paige Williams, Elizabeth Woods, Carol Worrell, F Minglana, M E Paul, C D Jackson, M H Rathore, A Khayat, K Champion, S Cusic, R Yogev, E Chadwick, I Febo-Rodriguez, S Nieves, M Purswani, S Baksi, E Stuard, M Dummit, M Acevedo, M Gonzalez, L Fabregas, M E Texidor, G B Scott, C D Mitchell, L Taybo, S Willumsen, L Bettica, J Amour, B Dashefsky, J Oleske, M Silio, T Alchediak, C Borne, M Cowie, S A Spector, R Viani, M Caffery, L Proctor, S Rana, D Darbari, J C Roa, P H Yu, M Donovan, R Serrano, M Burey, R Auguste, J Chen, J Foster, B W Stechenberg, D J Fisher, A M Johnston, M Toye, J Homans, M Neely, L S Spencer, A Kovacs, S Burchett, N Karthas, E Moore, C Cromer, P M Flynn, N Patel, M Donohoe, S Jones, W Borkowsky, S Chandwani, N Deygoo, S Akleh, E Handelsman, H J Moallem, D M Swindell, J M Kaye, A Higgins, M Foca, P LaRussa, A Gershon, R M Rutstein, C A Vincent, S D Douglas, G A Koutsoubis, A Petru, T Courville, D Wara, D Trevithick, E McFarland, C Salbenblatt, N Hutton, B Griffith, M Joyner, C Kiefner, M Acker, R Croteau, C McLellan, K Mohan, M Bamji, I Pathak, S Manwani, E Patel, H Spiegel, V Amos, K Luzuriaga, R Pass, M Crain, J Farley, K Klipner, V R Bonagura, S J Schuval, C Colter, L Campbell, S I Pelton, A M Reagan, K C Rich, K Hayani, M Bicchinella, S Nachman, D Ferraro, S Madjar, A Puga, F Wiley, K Whitfield, O Johnson, R Dizney, S Champion, M Frere, M DiGrado, E J Abrams, J Martinez, M Mancao, J Salazar, G Karas, T Belho, B Pitkin, J Eddleman, W Figueroa, E Reyes, L B Weiner, K A Contello, W A Holz, M J Famiglietti, R Lawrence, J Lew, C Delany, C Duff, A D Fernandez, P A Hughes, N Wade, M E Adams, J P Piatt, J Foti, L Clarke-Steffen, J Sleasman, C Delaney, C S Mani, W A Andiman, S Romano, L Hurst, J de Jesus, G Wilson, G A Weinberg, F Gigliotti, B Murante, S Laverty, N Hutchcon, A Townley, S Nesheim, R Dennis, P Emmanuel, J Lujan-Zilberman, C Graisberry, S Moore, R G Fisher, K M Cunnion, T T Rubio, D Sandifer, G M Johnson, H Gay, S Sadler, M Keller, J Hayes, A Gagajena, C Mink, D Johnson, J Church, T Dunaway, C Salata, A Deveikis, L Melton, S Gaur, P Whitley-Williams, A Malhotra, L Cerracchio, M Dolan, J D'Agostino, R Posada, C Mani, S Cobb, S R Lavoie, T Y Smith, A Feingold, S Burrows-Clark, J Mrus, R Beiting, M Brady, J Hunkler, K Koranyi, W Albritton, R Warford, S Arpadi, A Gershon, P Miller, A Rubinstein, G Krienik, A Kovacs, E Operskalski, D Wara, A Kamrin, S Farrales, R Johan-Liang, K O'Keefe, K A McGann, L Pickering, G A Storch, S Pahwa, L Rodriquez, P Lewis, R Croteau
Abstract
The impact of behavioral functioning on medication adherence in children with perinatally acquired HIV infection is not well-explored, but has important implications for intervention. This report addresses the relationship between behavioral functioning and child self-report or caregiver report of medication adherence among children and adolescents enrolled in Pediatric AIDS Clinical Trials Group Protocol 219C (conducted 2000-2007). A total of 1134 participants, aged 3-17 years, received a behavioral evaluation and adherence assessment. Complete adherence was defined as taking 100% of prescribed antiretroviral medications during three days preceding the study visit. Multivariable logistic regression models were used to evaluate associations between adherence and behavioral functioning, adjusting for potential confounders, including demographic, psychosocial, and health factors. Children demonstrated higher than expected rates of behavioral impairment (≈7% expected with T > 65) in the areas of conduct problems (14%, z = 7.0, p < 0.001), learning problems (22%, z = 12.2, p < 0.001), somatic complaints (22%, z = 12.6, p < 0.001), impulsivity-hyperactivity (20%, z = 11.1, p < 0.001), and hyperactivity (19%, z = 10.6, p < 0.001). Children with behavioral impairment in one or more areas had significantly increased odds of nonadherence [adjusted odds ratio (aOR) = 1.49, p = 0.04]. The odds of nonadherence were significantly higher for those with conduct problems and general hyperactivity (aOR = 2.03, p = 0.005 and aOR = 1.68, p = 0.02, respectively). Psychosocial and health factors, such as recent stressful life events and higher HIV RNA levels, were also associated with nonadherence. Knowledge of behavioral, health, and social influences affecting the child and family should guide the development of appropriate, evidence-based interventions for medication adherence.
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Source: PubMed