Vreeman Rachel C, Wiehe Sarah E, Pearce Emily C, Nyandiko Winstone M
Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
Pediatr Infect Dis J. 2008 Aug;27(8):686-91. doi: 10.1097/INF.0b013e31816dd325.
Sustaining antiretroviral therapy (ART) adherence requires accurate, consistent monitoring, a particular challenge for low-income countries. The optimal strategy to measure pediatric adherence remains unclear.
To conduct a systematic review of pediatric ART adherence measurement techniques, adherence estimates, and clinical correlates in low- and middle-income countries to inform ART adherence monitoring.
We searched online bibliographic databases, including MEDLINE and EMBASE, using systematic criteria. Two reviewers selected all descriptive or interventional studies involving nonpregnant, HIV-positive individuals < or =18 years old that measured ART adherence in low- or middle-income countries as defined by World Bank criteria. Data were extracted regarding sample characteristics, study setting, measurement strategy, adherence estimate, and adherence correlates.
The search yielded 1566 titles, of which 17 met selection criteria. Adherence measurement strategies included self- or proxy-report measures (14 studies), pill counts (4 studies), pharmacy records, drug levels, clinic adherence, and directly observed therapy (1 study each). The self- or proxy-report measures were heterogeneous, and few employed validation strategies. Caregiver-reported adherence was generally higher than self-report estimates. Pill counts revealed lower adherence estimates. Estimates of ART adherence ranged from 49% to 100%, with 76% of articles reporting >75% adherence. Factors related to family structure, socioeconomic status, disclosure, and medication regimen were all significantly associated with ART adherence.
Pediatric HIV care programs in low- and middle-income countries use heterogeneous methods to measure ART adherence. Adherence estimates vary substantially, but most studies from low- and middle-income countries report >75% adherence, whereas most studies from high-income countries report <75% adherence.
维持抗逆转录病毒疗法（ART）的依从性需要准确、持续的监测，这对低收入国家来说是一项特殊挑战。测量儿童依从性的最佳策略仍不明确。
对低收入和中等收入国家中测量儿童ART依从性的技术、依从性估计值及临床相关因素进行系统综述，为ART依从性监测提供信息。
我们使用系统标准在包括MEDLINE和EMBASE在内的在线书目数据库中进行检索。两名评审员选择了所有涉及未怀孕、年龄小于或等于18岁的HIV阳性个体的描述性或干预性研究，这些研究测量了世界银行标准所定义的低收入或中等收入国家的ART依从性。提取了有关样本特征、研究背景、测量策略、依从性估计值及依从性相关因素的数据。
检索得到1566个标题，其中17个符合入选标准。依从性测量策略包括自我报告或代理报告测量（14项研究）、药丸计数（4项研究）、药房记录、药物水平、诊所依从性以及直接观察疗法（各1项研究）。自我报告或代理报告测量方法各异，很少采用验证策略。照顾者报告的依从性通常高于自我报告估计值。药丸计数显示依从性估计值较低。ART依从性估计值范围为49%至100%，76%的文章报告依从性>75%。与家庭结构、社会经济地位、信息披露和药物治疗方案相关的因素均与ART依从性显著相关。
低收入和中等收入国家的儿童HIV护理项目使用多种不同方法来测量ART依从性。依从性估计值差异很大，但大多数来自低收入和中等收入国家的研究报告依从性>75%，而大多数来自高收入国家的研究报告依从性<75%。
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