A systematic review of pediatric adherence to antiretroviral therapy in low- and middle-income countries

Rachel Vreeman, Sarah Wiehe, Emily C. Pearce, Winstone M. Nyandiko

Research output: Contribution to journalArticle

123 Citations (Scopus)

Abstract

Background: Sustaining antiretroviral therapy (ART) adherence requires accurate, consistent monitoring, a particular challenge for low-income countries. The optimal strategy to measure pediatric adherence remains unclear. Objective: To conduct a systematic review of pediatric ART adherence measurement techniques, adherence estimates, and clinical correlates in low- and middle-income countries to inform ART adherence monitoring. METHODS:: We searched online bibliographic databases, including MEDLINE and EMBASE, using systematic criteria. Two reviewers selected all descriptive or interventional studies involving nonpregnant, HIV-positive individuals ≤18 years old that measured ART adherence in low- or middle-income countries as defined by World Bank criteria. Data were extracted regarding sample characteristics, study setting, measurement strategy, adherence estimate, and adherence correlates. Results: The search yielded 1566 titles, of which 17 met selection criteria. Adherence measurement strategies included self- or proxy-report measures (14 studies), pill counts (4 studies), pharmacy records, drug levels, clinic adherence, and directly observed therapy (1 study each). The self- or proxy-report measures were heterogeneous, and few employed validation strategies. Caregiver-reported adherence was generally higher than self-report estimates. Pill counts revealed lower adherence estimates. Estimates of ART adherence ranged from 49% to 100%, with 76% of articles reporting >75% adherence. Factors related to family structure, socioeconomic status, disclosure, and medication regimen were all significantly associated with ART adherence. Conclusions: Pediatric HIV care programs in low- and middle-income countries use heterogeneous methods to measure ART adherence. Adherence estimates vary substantially, but most studies from low- and middle-income countries report >75% adherence, whereas most studies from high-income countries report <75% adherence.

Original languageEnglish
Pages (from-to)686-691
Number of pages6
JournalPediatric Infectious Disease Journal
Volume27
Issue number8
DOIs
StatePublished - Aug 2008

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Pediatrics
Proxy
Therapeutics
Directly Observed Therapy
HIV
Bibliographic Databases
United Nations
Disclosure
Social Class
MEDLINE
Self Report
Patient Selection
Caregivers
Pharmaceutical Preparations

Keywords

  • Adherence
  • Antiretroviral therapy
  • ART
  • HIV
  • Human immunodeficiency virus
  • Measurement
  • Pediatrics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Infectious Diseases
  • Microbiology (medical)

Cite this

A systematic review of pediatric adherence to antiretroviral therapy in low- and middle-income countries. / Vreeman, Rachel; Wiehe, Sarah; Pearce, Emily C.; Nyandiko, Winstone M.

In: Pediatric Infectious Disease Journal, Vol. 27, No. 8, 08.2008, p. 686-691.

Research output: Contribution to journalArticle

Vreeman, Rachel ; Wiehe, Sarah ; Pearce, Emily C. ; Nyandiko, Winstone M. / A systematic review of pediatric adherence to antiretroviral therapy in low- and middle-income countries. In: Pediatric Infectious Disease Journal. 2008 ; Vol. 27, No. 8. pp. 686-691.
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