Predictors of Antiretroviral Medication Adherence Among a Diverse Cohort of Adolescents With HIV



      To compare prevalence and describe predictors of antiretroviral treatment adherence among adolescents with HIV acquired perinatally (PIY) or through risk behaviors (BIY).


      Data were obtained from the baseline assessment of Adolescent Impact, an intervention for HIV-infected adolescents receiving care in three U.S. cities. Patients self-reported missed medication doses as well as medication factors, HIV knowledge, disclosure, substance use, mental health, and social support through face-to-face or computer-assisted interviews.


      Of 104 participants, 68 (65.4%) reported full adherence. Compared with BIY, PIY were younger, had greater HIV disease severity, and had more structural supports. Adjusting for transmission mode (PIY vs. BIY), nonadherence by self-report was associated with higher viral load (VL) (adjusted odds ratio [AOR] = 1.5, confidence interval [CI] = 1.03, 2.18). Nonadherent adolescents were significantly likely to have had AIDS, discussed HIV disease with providers, reported difficulty with medication routine, experienced internalizing behavior problems, and used drugs. In multivariate analyses, independent predictors of nonadherence included acquiring HIV behaviorally (AOR = 4.378, CI = 1.055, 18.165), ever having AIDS (AOR = 4.78, CI = 1.31, 17.49), perceiving difficult medication routine (AOR = 1.84, CI = 1.07, 3.16), discussing disease indicators with provider (AOR = 4.57, CI = 1.74, 11.98), and missing doses because of forgetting (AOR = 2.53, CI = 1.29, 4.96). Adjusting for transmission mode, detectable VL was associated with lower recent CD4+ lymphocyte counts, discussing disease indicators with providers, and missing doses because of forgetting or being depressed. Low recent CD4+ lymphocyte counts (AOR = .988, p = .024) but fewer HIV symptoms (AOR = .466, p = .032) and missing doses because of forgetting (AOR = 1.76, p = .05) were independently associated with detectable VL in multivariate analysis.


      Despite differences between groups, nonadherence was associated with severity of illness, difficult medication routine, and forgetfulness. Beyond individual needs, both groups of adolescents had suboptimal adherence and would benefit from simplified medication routines and organizational skills.


      To read this article in full you will need to make a payment


      Subscribe to Journal of Adolescent Health
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Paterson D.L.
        • Swindells S.
        • Mohr J.
        • et al.
        Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.
        Ann Intern Med. 2000; 133: 21-30
        • Paterson D.L.
        • Potoski B.
        • Capitano B.
        Measurement of adherence to antiretroviral medications.
        J Acquir Immune Defic Syndr. 2002; 31: S103-S106
        • Simoni J.M.
        • Kurth A.E.
        • Pearson C.R.
        • et al.
        Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management.
        AIDS Behav. 2006; 10: 227-245
        • Bartlett J.A.
        Addressing the challenges of adherence.
        J Acquir Immune Defic Syndr. 2002; 29: S2-S10
        • Eldred L.
        • Cheever L.
        Update on adherence to HIV therapy.
        Hopkins HIV Rep. 1998; 10: 10-11
        • Ickovics J.R.
        • Meisler A.W.
        Adherence in AIDS clinical trials: A framework for clinical research and clinical care.
        J Clin Epidemiol. 1997; 50: 385-391
        • Chesney M.A.
        Factors affecting adherence to antiretroviral therapy.
        Clin Infect Dis. 2000; 30: S171-S176
        • Singh N.
        • Berman S.M.
        • Swindells S.
        • et al.
        Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy.
        Clin Infect Dis. 1999; 29: 824-830
        • Ammassari A.
        • Antinori A.
        • Aloisi M.S.
        • et al.
        Depressive symptoms, neurocognitive impairment, and adherence to highly active antiretroviral therapy among HIV-infected persons.
        Psychosomatics. 2004; 45: 394-402
        • Simoni J.M.
        • Frick P.A.
        • Lockhart D.
        • Liebovitz D.
        Mediators of social support and antiretroviral adherence among an indigent population in New York City.
        AIDS Patient Care STDs. 2002; 16: 431-439
        • Roberts K.J.
        Barriers to and facilitators of HIV-positive patients' adherence to antiretroviral treatment regimens.
        AIDS Patient Care STDs. 2000; 14: 155-168
        • Gifford A.L.
        • Bormann J.E.
        • Shively M.J.
        • et al.
        Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens.
        J Acquir Immune Defic Syndr. 2000; 23: 386-395
        • DeMasi R.A.
        • Graham N.M.
        • Tolson J.M.
        • et al.
        Correlation between self-reported adherence to highly active antiretroviral therapy (HAART) and virologic outcome.
        Adv Ther. 2001; 18: 163-173
        • Murphy D.A.
        • Marelich W.D.
        • Hoffman D.
        • Steers W.N.
        Predictors of antiretroviral adherence.
        AIDS Care. 2004; 16: 471-484
        • Rudy B.J.
        • Murphy D.A.
        • Harris D.R.
        • et al.
        Patient-related risks for nonadherence to antiretroviral therapy among HIV-infected youth in the United States: A study of prevalence and interactions.
        AIDS Patient Care STDs. 2009; 23: 185-194
        • Naar-King S.
        • Templin T.
        • Wright K.
        • et al.
        Psychosocial factors and medication adherence in HIV-positive youth.
        AIDS Patient Care STDs. 2006; 20: 44-47
        • Lima V.D.
        • Geller J.
        • Bangsberg D.R.
        • et al.
        The effect of adherence on the association between depressive symptoms and mortality among HIV-infected individuals first initiating HAART.
        AIDS. 2007; 21: 1175-1183
        • Ding H.
        • Wilson C.M.
        • Modjarrad K.
        • et al.
        Predictors of suboptimal virologic response to highly active antiretroviral therapy among human immunodeficiency virus-infected adolescents: Analyses of the reaching for excellence in adolescent care and health (REACH) project.
        Arch Pediatr Adolesc Med. 2009; 163: 1100-1105
        • Murphy D.A.
        • Wilson C.M.
        • Durako S.J.
        • et al.
        Antiretroviral medication adherence among the REACH HIV-infected adolescent cohort in the USA.
        AIDS Care. 2001; 13: 27-40
        • Belzer M.E.
        • Fuchs D.N.
        • Luftman G.S.
        • Tucker D.J.
        Antiretroviral adherence issues among HIV-positive adolescents and young adults.
        J Adolesc Health. 1999; 25: 316-319
        • Bell D.
        • Martinez J.
        • Camacho R.
        • et al.
        Factors associated with adolescent HIV treatment adherence.
        J Adolesc Health. 2000; 26: 108
        • Rudy B.J.
        • Murphy D.A.
        • Harris D.R.
        • et al.
        Prevalence and interactions of patient-related risks for nonadherence to antiretroviral therapy among perinatally infected youth in the United States.
        AIDS Patient Care STDs. 2010; 24: 97-104
        • Chandwani S.
        • Abramowitz S.
        • Koenig L.
        • et al.
        A multimodal behavioral intervention to impact adherence and risk behavior among perinatally and behaviorally HIV-infected youth: Description, delivery and receptivity of adolescent impact.
        AIDS Educ Prev. 2011; 23: 222-235
        • Chesney M.A.
        • Ickovics J.R.
        • Chambers D.B.
        • et al.
        Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments.
        AIDS Care. 2000; 12: 255-266
        • Abramowitz S.
        • Barnes W.
        • Koenig L.J.
        • et al.
        What do HIV-infected youth know about HIV/AIDS?.
        CDC HIV prevention Conference, Atlanta, GA2007
        • Beck A.T.
        • Ward C.H.
        • Mendelson M.
        • et al.
        An inventory for measuring depression.
        Arch Gen Psychiatry. 1961; 4: 561-571
        • Song L.-Y.
        • Singh J.
        • Singer M.
        The Youth Self-Report inventory: A study of its measurement fidelity.
        Psychol Assess. 1994; 6: 236-245
        • Sherbourne C.D.
        • Stewart A.L.
        The MOS social support survey.
        Soc Sci Med. 1991; 32: 705-714
        • Arnsten J.H.
        • Demas P.A.
        • Farzadegan H.
        • et al.
        Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring.
        Clin Infect Dis. 2001; 33: 1417-1423
        • Wagner G.J.
        • Rabkin J.G.
        Measuring medication adherence: Are missed doses reported more accurately then perfect adherence?.
        AIDS Care. 2000; 12: 405-408
        • Koenig L.J.
        • Nesheim S.
        • Abramowitz S.
        Adolescents with perinatally acquired HIV: Emerging behavioral and health needs for long-term survivors.
        Curr Opin Obstet Gynecol. 2011; 23: 321-327
        • Nieuwkerk P.T.
        • Oort F.J.
        Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: A meta-analysis.
        J Acquir Immune Defic Syndr. 2005; 38: 445-448
        • Bangsberg D.R.
        • Charlebois E.D.
        • Grant R.M.
        • et al.
        High levels of adherence do not prevent accumulation of HIV drug resistance mutations.
        AIDS. 2003; 17: 1925-1932
        • Murphy D.A.
        • Belzer M.
        • Durako S.J.
        • et al.
        Longitudinal antiretroviral adherence among adolescents infected with human immunodeficiency virus.
        Arch Pediatr Adolesc Med. 2005; 159: 764-770
        • Yin H.S.
        • Forbis S.G.
        • Dreyer B.P.
        Health literacy and pediatric health.
        Curr Probl Pediatr Adolesc Health Care. 2007; 37: 258-286
        • Maggiolo F.
        • Ripamonti D.
        • Arici C.
        • et al.
        Simpler regimens may enhance adherence to antiretrovirals in HIV-infected patients.
        HIV Clin Trials. 2002; 3: 371-378
        • Williams P.L.
        • Storm D.
        • Montepiedra G.
        • et al.
        Predictors of adherence to antiretroviral medications in children and adolescents with HIV infection.
        Pediatrics. 2006; 118: e1745-e1757
        • Hosek S.
        • Harper G.W.
        • Domanico R.
        Predictors of medication adherence among HIV-infected youth.
        Psychol Health Med. 2005; 10: 166-179
        • Murphy D.A.
        • Sarr M.
        • Durako S.J.
        • et al.
        Barriers to HAART adherence among human immunodeficiency virus-infected adolescents.
        Arch Pediatr Adolesc Med. 2003; 157: 249-255
        • Rigsby M.O.
        • Rosen M.I.
        • Beauvais J.E.
        • et al.
        Cue-dose training with monetary reinforcement: Pilot study of an antiretroviral adherence intervention.
        J Gen Intern Med. 2000; 15: 841-847
        • Wise J.
        • Operario D.
        Use of electronic reminder devices to improve adherence to antiretroviral therapy: A systematic review.
        AIDS Patient Care STDs. 2008; 22: 495-504
        • Koenig L.J.
        • Bachanas P.J.
        Adherence to medications for HIV: Teens say, “too many, too big, too often.”.
        in: Lyon M.E. D'Angelo L. Teenagers, HIV, AIDS: Insights from Adolescents Living with the Virus. Praeger Publishers/Division of Greenwood, Westport, CT2006
        • Tucker J.S.
        • Orlando M.
        • Burnam M.A.
        • et al.
        Psychosocial mediators of antiretroviral nonadherence in HIV-positive adults with substance use and mental health problems.
        Health Psychol. 2004; 23: 363-370
        • Gonzalez J.S.
        • Penedo F.J.
        • Antoni M.H.
        • et al.
        Social support, positive states of mind, and HIV treatment adherence in men and women living with HIV/AIDS.
        Health Psychol. 2004; 23: 413-418