Antiretroviral Medication Adherence and Disease Management in Pediatric Populations

Accounting for 26% of all new HIV infections in the US each year, adolescents and young adults remain highly vulnerable to HIV. Current guidelines recommend starting antiretroviral therapy (ART) as soon as individuals are diagnosed with HIV, yet adherence to HIV medications remains suboptimal, especially among youth. Further, there are significant disparities in ART adherence across various sociodemographic groups with research indicating lower rates of adherence among racial/ethnic minorities, individuals from lower socioeconomic status, older adolescents, and female youth. Considering the detrimental consequences of untreated and/or poorly managed HIV, understanding factors that contribute to poor adherence among youth is critical. This chapter provides an overview of psychosocial, structural, and treatment-related barriers and facilitators to HIV medication adherence among children and adolescents/young adults with behaviorally or perinatally acquired HIV infection (BaHIV, PaHIV). Best practices for measuring adherence in youth, including self-report, pill counts and refills, electronic monitoring, and viral load/CD4 count, are reviewed as well as published adherence interventions in clinic and home/community settings, and interventions incorporating the use of technology. We also discuss the importance of considering multicultural factors in adherence interventions and provide suggested future directions for research and practice with pediatric populations.