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dc.contributor.authorHaberer, Jessica
dc.contributor.authorKiwanuka, Julius
dc.contributor.authorNansera, Denis
dc.contributor.authorRagland, Kathleen
dc.contributor.authorMellins, Claude
dc.contributor.authorBangsberg, David Roy
dc.date.accessioned2013-03-08T16:45:48Z
dc.date.issued2012
dc.identifier.citationHaberer, Jessica E., Julius Kiwanuka, Denis Nansera, Kathleen Ragland, Claude Mellins, and David R. Bangsberg. 2012. Multiple measures reveal antiretroviral adherence successes and challenges in HIV-infected Ugandan children. PLoS ONE 7(5): e36737.en_US
dc.identifier.issn1932-6203en_US
dc.identifier.urihttp://nrs.harvard.edu/urn-3:HUL.InstRepos:10381364
dc.description.abstractBackground: Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. Methodology/Principal Findings: To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2–10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of \(\geq\)48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = −0.25, p = 0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6–5.5; p = 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0–2.0; p = 0.04), and caregiver’s alcohol use (AOR 3.1, 95%CI 1.8–5.2; p<0.0001). Child’s use of co-trimoxazole (AOR 0.5, 95%CI 0.4–0.9; p = 0.009), caregiver’s use of ART (AOR 0.6, 95%CI 0.4–0.9; p = 0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4–0.8; p = 0.001), and caregiver feeling ashamed of child’s HIV status (AOR 0.5, 95%CI 0.3–0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5–11.5; p = 0.009) and caregiver’s alcohol use (AOR 5.5, 95%CI 2.8–10.7; p<0.0001) were associated with \(\geq\)48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1–0.99; p = 0.049) and increasing assets (AOR 0.7, 95%CI 0.6–0.9; p = 0.0007) were protective against these interruptions. Conclusions/Significance: Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development.en_US
dc.language.isoen_USen_US
dc.publisherPublic Library of Scienceen_US
dc.relation.isversionofdoi:10.1371/journal.pone.0036737en_US
dc.relation.hasversionhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348916/pdf/en_US
dash.licenseLAA
dc.subjectBiologyen_US
dc.subjectPopulation Biologyen_US
dc.subjectEpidemiologyen_US
dc.subjectInfectious Disease Epidemiologyen_US
dc.subjectMedicineen_US
dc.subjectClinical Research Designen_US
dc.subjectPediatric Epidemiologyen_US
dc.subjectInfectious Diseasesen_US
dc.subjectViral Diseasesen_US
dc.subjectHIVen_US
dc.subjectHIV epidemiologyen_US
dc.subjectMental Healthen_US
dc.subjectPsychologyen_US
dc.subjectBehavioren_US
dc.subjectHabitsen_US
dc.subjectPediatricsen_US
dc.subjectSocial and Behavioral Sciencesen_US
dc.titleMultiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Childrenen_US
dc.typeJournal Articleen_US
dc.description.versionVersion of Recorden_US
dc.relation.journalPLoS ONEen_US
dash.depositing.authorHaberer, Jessica
dc.date.available2013-03-08T16:45:48Z
dc.identifier.doi10.1371/journal.pone.0036737*
dash.contributor.affiliatedHaberer, Jessica
dash.contributor.affiliatedBangsberg, David R.


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