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Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV

This study identified factors associated with adherence to a 6-month isoniazid preventive therapy (IPT) course among adolescents and children living with HIV. Forty adolescents living with HIV and 48 primary caregivers of children living with HIV completed a Likert-based survey to measure respondent...

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Autores principales: Kay, Alexander W., Thivalapill, Neil, Skinner, Donald, Dube, Gloria Sisi, Dlamini, Nomathemba, Mzileni, Bulisile, Fuentes, Patricia, Ustero, Pilar, Adams, Lisa V., Mandalakas, Anna M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746166/
https://www.ncbi.nlm.nih.gov/pubmed/33332462
http://dx.doi.org/10.1371/journal.pone.0243713
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author Kay, Alexander W.
Thivalapill, Neil
Skinner, Donald
Dube, Gloria Sisi
Dlamini, Nomathemba
Mzileni, Bulisile
Fuentes, Patricia
Ustero, Pilar
Adams, Lisa V.
Mandalakas, Anna M.
author_facet Kay, Alexander W.
Thivalapill, Neil
Skinner, Donald
Dube, Gloria Sisi
Dlamini, Nomathemba
Mzileni, Bulisile
Fuentes, Patricia
Ustero, Pilar
Adams, Lisa V.
Mandalakas, Anna M.
author_sort Kay, Alexander W.
collection PubMed
description This study identified factors associated with adherence to a 6-month isoniazid preventive therapy (IPT) course among adolescents and children living with HIV. Forty adolescents living with HIV and 48 primary caregivers of children living with HIV completed a Likert-based survey to measure respondent opinions regarding access to care, quality of care, preferred regimens, perceived stigma, and confidence in self-efficacy. Sociodemographic data were collected and adherence measured as the average of pill counts obtained while on IPT. The rates of suboptimal adherence (< 95% adherent) were 22.5% among adolescents and 37.5% among the children of primary caregivers. Univariate logistic regression was used to model the change in the odds of suboptimal adherence. Independent factors associated with suboptimal adherence among adolescents included age, education level, the cost of coming to clinic, stigma from community members, and two variables relating to self-efficacy. Among primary caregivers, child age, concerns about stigma, and location preference for meeting a community-health worker were associated with suboptimal adherence. To determine whether these combined factors contributed different information to the prediction of suboptimal adherence, a risk score containing these predictors was constructed for each group. The risk score had an AUC of 0.87 (95% CI: 0.76, 0.99) among adolescents and an AUC of 0.76 (95% CI: 0.62, 0.90), among primary caregivers suggesting that these variables may have complementary predictive utility. The heterogeneous scope and associations of these variables in different populations suggests that interventions aiming to increase optimal adherence will need to be tailored to specific populations and multifaceted in nature. Ideally interventions should address both long-established barriers to adherence such as cost of transportation to attend clinic and more nuanced psychosocial barriers such as perceived community stigma and confidence in self-efficacy.
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spelling pubmed-77461662020-12-31 Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV Kay, Alexander W. Thivalapill, Neil Skinner, Donald Dube, Gloria Sisi Dlamini, Nomathemba Mzileni, Bulisile Fuentes, Patricia Ustero, Pilar Adams, Lisa V. Mandalakas, Anna M. PLoS One Research Article This study identified factors associated with adherence to a 6-month isoniazid preventive therapy (IPT) course among adolescents and children living with HIV. Forty adolescents living with HIV and 48 primary caregivers of children living with HIV completed a Likert-based survey to measure respondent opinions regarding access to care, quality of care, preferred regimens, perceived stigma, and confidence in self-efficacy. Sociodemographic data were collected and adherence measured as the average of pill counts obtained while on IPT. The rates of suboptimal adherence (< 95% adherent) were 22.5% among adolescents and 37.5% among the children of primary caregivers. Univariate logistic regression was used to model the change in the odds of suboptimal adherence. Independent factors associated with suboptimal adherence among adolescents included age, education level, the cost of coming to clinic, stigma from community members, and two variables relating to self-efficacy. Among primary caregivers, child age, concerns about stigma, and location preference for meeting a community-health worker were associated with suboptimal adherence. To determine whether these combined factors contributed different information to the prediction of suboptimal adherence, a risk score containing these predictors was constructed for each group. The risk score had an AUC of 0.87 (95% CI: 0.76, 0.99) among adolescents and an AUC of 0.76 (95% CI: 0.62, 0.90), among primary caregivers suggesting that these variables may have complementary predictive utility. The heterogeneous scope and associations of these variables in different populations suggests that interventions aiming to increase optimal adherence will need to be tailored to specific populations and multifaceted in nature. Ideally interventions should address both long-established barriers to adherence such as cost of transportation to attend clinic and more nuanced psychosocial barriers such as perceived community stigma and confidence in self-efficacy. Public Library of Science 2020-12-17 /pmc/articles/PMC7746166/ /pubmed/33332462 http://dx.doi.org/10.1371/journal.pone.0243713 Text en © 2020 Kay et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kay, Alexander W.
Thivalapill, Neil
Skinner, Donald
Dube, Gloria Sisi
Dlamini, Nomathemba
Mzileni, Bulisile
Fuentes, Patricia
Ustero, Pilar
Adams, Lisa V.
Mandalakas, Anna M.
Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV
title Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV
title_full Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV
title_fullStr Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV
title_full_unstemmed Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV
title_short Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV
title_sort predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with hiv
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7746166/
https://www.ncbi.nlm.nih.gov/pubmed/33332462
http://dx.doi.org/10.1371/journal.pone.0243713
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