P1042S (VERSION 10) COGNITIVE, BEHAVIORAL AND PSYCHOSOCIAL CORRELATES OF MED

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This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In recent years, medication adherence has become a critical issue for HIV-infected children and adolescents because of drug resistance and the increased complexity of treatment regimens. In antiretroviral clinical trials, non- adherence to medication complicates our ability to measure the effectiveness of new drugs, and the lower response rate observed in children compared to adults is partially explained by problems with adherence. Medication adherence becomes increasingly problematic during adolescence. The growing population of preteens and adolescents with perinatally acquired HIV infection demands an understanding of factors that influence medication adherence. Effective interventions that promote adherence and can be integrated into both clinical care and research need to be developed. Clinicians should understand what factors influence an adolescent's ability to follow a complex treatment regimen before therapy is initiated. Primary study objectives are: 1)To assess the relationship of age, cognitive, behavioral, and psychosocial, functioning (including language, memory, attention, and academic skills) with adherence to medication regimens, as measured by self-report and pill count.; 2) To assess the relationship of age, cognitive, behavioral, and psychosocial functioning with the degree of responsibility for taking medications placed on participants, as measured by caregiver and self-report questionnaires. Secondary objectives are: 1) To characterize cognitive, behavioral, and psychosocial functioning in children and adolescents with perinatally acquired HIV infection; 2) To correlate cognitive, behavioral, and psychosocial functioning with virologic and disease variables; 3) To assess interactions between participants? cognitive status and the complexity of their medication regimens in predicting adherence, as measured by self-report and pill count; 4) To assess the ability of baseline cognitive, behavioral, and psychosocial variables to predict adherence at a later time point (24 and 48 weeks following enrollment); 5) To assess the correlation of self-report and pill count measures of adherence; 6) To assess the stability of adherence over time as measured by self-report and pill counts; 7) To correlate measures of adherence with disease severity as measured by viral load, CDC disease category and CD4 counts, and to assess whether the association between adherence and disease severity is stable over time; and 8) To develop a predictive model that could be used by clinicians to identify children and adolescents who are more likely to have problems adhering to their antiretroviral medication regimens.