PMID- 29466385 OWN - NLM STAT- MEDLINE DCOM- 20180326 LR - 20220410 IS - 1932-6203 (Electronic) IS - 1932-6203 (Linking) VI - 13 IP - 2 DP - 2018 TI - Adherence to antiretroviral therapy in a clinical cohort of HIV-infected children in East Africa. PG - e0191848 LID - 10.1371/journal.pone.0191848 [doi] LID - e0191848 AB - OBJECTIVE: To describe antiretroviral therapy (ART) adherence and associated factors for a large HIV-infected pediatric cohort followed by sites of the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) consortium. METHODS: This study utilized prospectively collected clinical data from HIV-infected children less than 13 years of age who initiated ART within 4 clinical care programs (with 26 clinical sites) in Kenya, Uganda, and Tanzania and were followed for up to 6 years. Programs used one of 3 adherence measures, including 7-day quantitative recall, 7-day categorical recall, and clinician pill assessments. We fit a hierarchical, three-level, logistic-regression model to examine adherence, with observations nested within patient, and patients within the 26 sites providing pediatric HIV data to this analysis. RESULTS: In East Africa, 3,304 children, 52.0% male, were enrolled in care and were subsequently observed for a median of 92 weeks (inter-quartile range [IQR] 50.3-145.0 weeks). Median age at ART initiation was 5.5 years ([IQR] 3.0-8.5 years). "Good" adherence, as reported by each clinic's measures, was extremely high, remaining on average above 90% throughout all years of follow-up. Longer time on ART was associated with higher adherence (adjusted Odds Ratio-aOR-per log-transformed week on ART: 1.095, 95% Confidence Interval-CI-[1.052-1.150].) Patients enrolled in higher-volume programs exhibited higher rates of clinician-assessed adherence (aOR per log-500 patients: 1.174, 95% CI [1.108-1.245]). Significant site-level variability in reported adherence was observed (0.28), with even higher variability among patients (0.71). In a sub-analysis, being an orphan at the start of ART was strongly associated with lower ART adherence rates (aOR: 0.919, 95% CI [0.864-0.976]). CONCLUSIONS: Self-reported adherence remained high over a median of 1.8 years in HIV care, but varied according to patient-level and site-level factors. Consistent adherence monitoring with validated measures and attention to vulnerable groups is recommended. FAU - Vreeman, Rachel C AU - Vreeman RC AUID- ORCID: 0000-0001-5460-8204 AD - Indiana University School of Medicine, Indianapolis, IN, United States of America. AD - Regenstrief Institute, Inc, Indianapolis, IN, United States of America. AD - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. AD - School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. FAU - Ayaya, Samuel O AU - Ayaya SO AD - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. AD - School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. FAU - Musick, Beverly S AU - Musick BS AD - Indiana University School of Medicine, Indianapolis, IN, United States of America. AD - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. FAU - Yiannoutsos, Constantin T AU - Yiannoutsos CT AD - Indiana University School of Medicine, Indianapolis, IN, United States of America. AD - R.M. Fairbanks School of Public Health, Indianapolis, IN, United States of America. FAU - Cohen, Craig R AU - Cohen CR AD - University of California San Francisco, San Francisco, CA, United States of America. FAU - Nash, Denis AU - Nash D AD - City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York, NY, United States of America. FAU - Wabwire, Deo AU - Wabwire D AD - Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda. FAU - Wools-Kaloustian, Kara AU - Wools-Kaloustian K AD - Indiana University School of Medicine, Indianapolis, IN, United States of America. AD - Regenstrief Institute, Inc, Indianapolis, IN, United States of America. AD - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. FAU - Wiehe, Sarah E AU - Wiehe SE AD - Indiana University School of Medicine, Indianapolis, IN, United States of America. AD - Regenstrief Institute, Inc, Indianapolis, IN, United States of America. AD - Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. LA - eng GR - 5K23MH087225-03/NH/NIH HHS/United States GR - U01 AI096299/AI/NIAID NIH HHS/United States GR - U01 AI069911/NH/NIH HHS/United States GR - U01 AI069911/AI/NIAID NIH HHS/United States GR - K23 MH087225/MH/NIMH NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, U.S. Gov't, Non-P.H.S. DEP - 20180221 PL - United States TA - PLoS One JT - PloS one JID - 101285081 RN - 0 (Anti-HIV Agents) SB - IM MH - Adolescent MH - Africa, Eastern MH - Anti-HIV Agents/*therapeutic use MH - Child MH - Child, Preschool MH - Female MH - HIV Infections/*drug therapy MH - Humans MH - Infant MH - Male MH - *Patient Compliance PMC - PMC5842873 COIS- Competing Interests: Several authors (RCV, KWK, SEW) are investigators affiliated with the Regenstrief Institute Inc, a center that is a unique affiliate of the Indiana University School of Medicine. The center does not provide support in the form of salaries for the authors. This does not alter our adherence to PLOS ONE policies on sharing data and materials. EDAT- 2018/02/22 06:00 MHDA- 2018/03/27 06:00 PMCR- 2018/02/21 CRDT- 2018/02/22 06:00 PHST- 2016/11/23 00:00 [received] PHST- 2018/01/08 00:00 [accepted] PHST- 2018/02/22 06:00 [entrez] PHST- 2018/02/22 06:00 [pubmed] PHST- 2018/03/27 06:00 [medline] PHST- 2018/02/21 00:00 [pmc-release] AID - PONE-D-16-46566 [pii] AID - 10.1371/journal.pone.0191848 [doi] PST - epublish SO - PLoS One. 2018 Feb 21;13(2):e0191848. doi: 10.1371/journal.pone.0191848. eCollection 2018.