Adherence among children and young people living with HIV/AIDS: A systematic review of medication and comprehensive interventions

Advancements in therapy, including the use of highly active antiretroviral therapy, have increased survival and decreased opportunistic infections in HIV pediatric and adolescent population. Previous studies have found that in general HIV persons who maintained consistent ad had lower viral loads and improved health status. Nevertheless, adherence among children, adolescents, and youth has been found to be suboptimal. This systematic review describes interventions that have been conducted to improve adherence among these segments of the population diagnosed with HIV/AIDS, in both developed and developing settings. We found 16 interventions and clinical trials conducted between 2000 and 2011; these were grouped into studies that focused strictly on the medication (n = 6) and others that focused on factors associated with medication adherence (n = 10). The results indicate that, in 11 years, few treatment adherence interventions were conducted, most of which took place in the United States; although some articles reported more comprehensive interventions, all of them ultimately aimed only to promote adherence to antiretrovirals. We conclude that interventions need to be more specifically created for children and youth in order to improve adherence and promote self-care in general, incorporating the social determinants approach with special emphasis on the needs of children, adolescents, and youth according to their age. It is also concluded that interventions should be implemented and evaluated in contexts where children and youth are severely affected by HIV in regions like Africa, Latin America, and the Caribbean.