Youth with HIV have suboptimal adherence to no-cost ART

Youth with HIV residing in British Columbia who received antiretroviral therapy, or ART, free of charge were less likely to reach optimal adherence to treatment regimens compared with adults aged 30 years or older, according to research published in the Journal of Adolescent Health.

“Despite significant progress in therapeutic regimens, AIDS-related deaths remain the second leading cause of death among youth aged 15 to 24 years globally,” Kalysha Closson, MSc, from the British Columbia Center for Excellence in HIV/AIDS, and colleagues wrote. “Viral suppression is associated with improved health outcomes, increased life expectancy and reduced risk of population-level HIV transmission to sexual partners, a phenomenon referred to as treatment as prevention.”

The researchers examined ART adherence among youth between the ages of 15 and 29 years and compared the rate with that of adults aged 30 years or older. Optimal adherence — 95% or more — was determined through pharmacy refill data.

The study included 7,485 people with HIV, and the median follow up was 7 years.

After adjusting for potential confounders, the researchers found that youth were significantly less likely to adhere to ART compared with adults (adjusted OR = 0.55; 95% CI, 0.49-0.62). However, the researchers observed an improvement in adherence between 2010 and 2016 in patients aged 19 to 24 years (23% to 43%) and patients aged 25 to 29 years (39% to 57%).

The number of years on ART (aOR = 1.15; 95% CI, 1.1-1.19) and increasing time-dependent age (aOR = 1.18/year older; 95% CI, 1.11-1.25) were both independently associated with optimal adherence, the researchers said, whereas less optimal adherence was associated with hepatitis C-positive serostatus (aOR = 0.55; 95% CI, 0.33-0.92) and multiple regimen changes during the study period (aOR = 0.89/regimen change; 95% CI, 0.81-0.97).

“Providers must endeavor to meet youth where they are and provide them with treatment options and multiple levels of support regarding health care,” Closson and colleagues wrote. “Evidence suggests that optimal clinical care for youth living with HIV incorporates comprehensive, multidisciplinary approaches to promote adherence. The most promising strategies for improving adherence among youth are holistic, culturally appropriate, involving patient and caregiver education, self-monitoring, peer support and telephone follow-up.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Published by:

Sources/Disclosures

Collapse

Source:

Closson K, et al. J Adolesc Health. 2018;doi:10.1016/j.adohealth.2018.10.001.