Comprehensive evaluation of caregiver-reported antiretroviral therapy adherence for HIV-Infected Children

Abstract

For HIV-infected children, adherence to antiretroviral therapy (ART) is often assessed by caregiver-report but there are few data on their validity. We conducted prospective evaluations with 191 children ages 0 to 14 years and their caregivers over 6 months in western Kenya to identify questionnaire items that best predicted adherence to ART. Medication Event Monitoring Systems® (MEMS, MWV/AARDEX Ltd, Switzerland) electronic dose monitors were used as external criterion for adherence. We employed a novel variable selection tool using the LASSO technique with logistic regression to identify items best correlated with dichotomized MEMS adherence (≥90% or <90% doses taken). Nine of 48 adherence items were identified as the best predictors of adherence, including missed or late doses in the past 7 days, problems giving the child medicines, and caregiver-level factors like not being present at medication taking. These items could be included in adherence assessment tools for pediatric patients.