Patient, Caregiver and regimen characteristics associated with adherence to highly active antiretroviral therapy among HIV-infected children and adolescents
Patient, Caregiver and regimen characteristics associated with adherence to highly active antiretroviral therapy among HIV-infected children and adolescents
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DOI：
10.1097/01.inf.0000250625.80340.48
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发表时间：
2007-01-01
影响因子：
3.6
通讯作者：
Wood, Lauren V.
中科院分区：
文献类型：
--
作者：
Martin, Staci;Elliott-DeSorbo, Deborah K.;Wood, Lauren V.
背景：本研究评估了儿童和照顾者对hiv阳性儿童的用药责任、疾病知识、治疗方案复杂性和坚持高效抗逆转录病毒治疗之间的关系。我们还研究了依从儿童和照顾者人口统计学特征和艾滋病毒疾病替代标志物的关系。方法：在这项为期6个月的纵向研究中，24名hiv阳性儿童（平均年龄= 14.0岁）接受了高效抗逆转录病毒治疗，他们的照顾者完成了用药责任和疾病知识的测量。用药事件监测系统限制了第1至3个月（时间1）和第4至6个月（时间2）的计算依从性。结果：用药事件监测系统数据显示，依从率在第1次为81%，第2次为79%。只有8% （n = 2）的儿童照顾者对报告完全同意谁负责与药物有关的任务。患者用药责任与年龄相关，基于儿童认知（r = 0.51）和护理者认知（r = 0.57; p < 0.05），但患者对用药方案的认知与年龄无关。照顾者对治疗方案的了解越多，儿童照顾者对药物责任的差异越少，这预示着更好的依从性（调整后R-2 = 0.45）。最后，依从性与时间1的CD4百分比（r = 0.50）和时间1 （r = - 0.56）和时间2的病毒载量（r = - 0.68; p < 0.05）相关。结论：hiv感染儿童的药物依从性低于最佳病毒抑制所需的药物依从性。依从性与艾滋病毒疾病的替代标志物有关，但与儿童或照顾者的人口统计学变量无关。应明确家庭成员对药物相关任务的责任，应强调治疗方案知识，护理人员应避免过早地将治疗责任分配给儿童。
Background: This study assesses the relationship between child and caregiver perceptions of medication responsibility, disease knowledge, regimen complexity and adherence to highly active antiretroviral therapy among HIV-positive children. We also examine the association of adherence to child and caregiver demographic characteristics and surrogate markers of HIV disease.Methods: For this 6-month longitudinal study, 24 HIV-positive children (mean age = 14.0 years) being treated with highly active antiretroviral therapy and their caregivers completed measures of medication responsibility and disease knowledge. Medication Event Monitoring System caps calculated adherence across months I through 3 (time 1) and 4 through 6 (time 2).Results: Medication Event Monitoring System data revealed adherence rates of 81% at time 1 and 79% at time 2. Only 8% (n = 2) of child-caregiver pairs reported complete agreement regarding who held responsibility for medication-related tasks. Patients' responsibility for medication was correlated with age based on child (r = .51) and caregiver (r = .57; Ps < 0.05) perceptions, although their regimen knowledge was not. Greater regimen knowledge among caregivers and fewer child-caregiver discrepancies about medication responsibility predicted better adherence (adjusted R-2 = .45). Finally, adherence was correlated with CD4 percentages at time 1 (r = .50) and viral load at time 1 (r = -.56) and time 2 (r = -.68; Ps < 0.05).Conclusions: Medication adherence among HIV-infected children is lower than required for optimal viral suppression. Adherence is related to surrogate markers of HIV disease but not to child or caregiver demographic variables. Responsibilities for medication-related tasks should be clarified among family members, regimen knowledge should be emphasized and caregivers should avoid assigning treatment responsibility to a child prematurely.