Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children

BACKGROUND: 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 >/= 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 /= 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.