The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children
Identifieur interne : 002983 ( Main/Exploration ); précédent : 002982; suivant : 002984The role of psychosocial and family factors in adherence to antiretroviral treatment in human immunodeficiency virus-infected children
Auteurs : Claude Ann Mellins [États-Unis] ; Elizabeth Brackis-Cott [États-Unis] ; Curtis Dolezal [États-Unis] ; Elaine J. Abrams [États-Unis]Source :
- The Pediatric infectious disease journal [ 0891-3668 ] ; 2004.
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Abstract
Background: The toxicity and complexity of antiretroviral therapy (ART) regimens are substantial challenges in the context of patients' lives. This study examines child psychosocial and caregiver/family factors influencing adherence to ART in perinatally human immunodeficiency virus (HIV)-infected children. Methods: Seventy-five children (ages 3-13 years) prescribed ART, and their primary caregivers were recruited from 2 urban pediatric HIV programs. A battery of psychologic assessments and self-report adherence data were collected from all caregivers and 48 children who were ≥ 7 years old. Results: Forty percent of caregivers and 56% of children reported missed doses of medication in the past month. Families in which the caregiver or child reported missed doses (nonadherent) were compared with families who reported no missed doses (adherent). In univariate analyses, nonadherence was significantly associated with older child age (P < 0.05), worse parent-child communication (P < 0.017), higher caregiver stress (P < 0.002), lower caregiver quality of life (P < 0.003) and worse caregiver cognitive functioning (P = 0.033), and of borderline significance in its association with increased (1) child responsibility for medications (P < 0.07), (2) HIV disclosure to the child (P < 0.07) and (3) child stress (P < 0.08) In logistic regressions controlling for age, caregiver/family factors were the most strongly associated with nonadherence, including worse parent-child communication (P < 0.03), higher caregiver stress (P < 0.01), less disclosure to others (P < 0.05) and quality of life (P < 0.01). Conclusions: Our data suggest that efforts to improve children's adherence to complex antiretroviral regimens requires addressing developmental, psychosocial and family factors.
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Abrams</name><affiliation wicri:level="2"><inist:fA14 i1="02"><s1>Department of Pediatrics, Harlem Hospital Center and Columbia University, College of Physicians and Surgeons</s1><s2>New York, NY</s2><s3>USA</s3><sZ>4 aut.</sZ></inist:fA14><country>États-Unis</country><placeName><region type="state">État de New York</region></placeName></affiliation></author></analytic><series><title level="j" type="main">The Pediatric infectious disease journal</title><title level="j" type="abbreviated">Pediatr. infect. dis. j.</title><idno type="ISSN">0891-3668</idno><imprint><date when="2004">2004</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The Pediatric infectious disease journal</title><title level="j" type="abbreviated">Pediatr. infect. dis. j.</title><idno type="ISSN">0891-3668</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>AIDS</term><term>Child</term><term>Drug compliance</term><term>Family study</term><term>Human immunodeficiency virus</term><term>Pediatrics</term><term>Treatment compliance</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>SIDA</term><term>Etude familiale</term><term>Observance médicamenteuse</term><term>Observance thérapeutique</term><term>Virus immunodéficience humaine</term><term>Enfant</term><term>Pédiatrie</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Enfant</term><term>Pédiatrie</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background: The toxicity and complexity of antiretroviral therapy (ART) regimens are substantial challenges in the context of patients' lives. This study examines child psychosocial and caregiver/family factors influencing adherence to ART in perinatally human immunodeficiency virus (HIV)-infected children. Methods: Seventy-five children (ages 3-13 years) prescribed ART, and their primary caregivers were recruited from 2 urban pediatric HIV programs. A battery of psychologic assessments and self-report adherence data were collected from all caregivers and 48 children who were ≥ 7 years old. Results: Forty percent of caregivers and 56% of children reported missed doses of medication in the past month. Families in which the caregiver or child reported missed doses (nonadherent) were compared with families who reported no missed doses (adherent). In univariate analyses, nonadherence was significantly associated with older child age (P < 0.05), worse parent-child communication (P < 0.017), higher caregiver stress (P < 0.002), lower caregiver quality of life (P < 0.003) and worse caregiver cognitive functioning (P = 0.033), and of borderline significance in its association with increased (1) child responsibility for medications (P < 0.07), (2) HIV disclosure to the child (P < 0.07) and (3) child stress (P < 0.08) In logistic regressions controlling for age, caregiver/family factors were the most strongly associated with nonadherence, including worse parent-child communication (P < 0.03), higher caregiver stress (P < 0.01), less disclosure to others (P < 0.05) and quality of life (P < 0.01). Conclusions: Our data suggest that efforts to improve children's adherence to complex antiretroviral regimens requires addressing developmental, psychosocial and family factors.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>État de New York</li></region></list><tree><country name="États-Unis"><region name="État de New York"><name sortKey="Mellins, Claude Ann" sort="Mellins, Claude Ann" uniqKey="Mellins C" first="Claude Ann" last="Mellins">Claude Ann Mellins</name></region><name sortKey="Abrams, Elaine J" sort="Abrams, Elaine J" uniqKey="Abrams E" first="Elaine J." last="Abrams">Elaine J. Abrams</name><name sortKey="Brackis Cott, Elizabeth" sort="Brackis Cott, Elizabeth" uniqKey="Brackis Cott E" first="Elizabeth" last="Brackis-Cott">Elizabeth Brackis-Cott</name><name sortKey="Dolezal, Curtis" sort="Dolezal, Curtis" uniqKey="Dolezal C" first="Curtis" last="Dolezal">Curtis Dolezal</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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