药物责任、执行功能和适应功能在围产期感染艾滋病毒的儿童和青少年坚持治疗中的作用。
Roles of Medication Responsibility, Executive and Adaptive Functioning in Adherence for Children and Adolescents With Perinatally Acquired HIV.
作者信息
Garvie Patricia A, Brummel Sean S, Allison Susannah M, Malee Kathleen M, Mellins Claude A, Wilkins Megan L, Harris Lynnette L, Patton E Doyle, Chernoff Miriam C, Rutstein Richard M, Paul Mary E, Nichols Sharon L
机构信息
From the *Research Department, Children's Diagnostic & Treatment Center, Fort Lauderdale, Florida; †Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, Massachusetts; ‡Division of AIDS Research, National Institute of Mental Health, Bethesda, Maryland; §Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ¶Department of Psychiatry and Sociomedical Sciences, HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, New York; ‖Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee; **Department of Pediatrics, Baylor College of Medicine, Houston, Texas; ††Private Practice, Fort Lauderdale, Florida; ‡‡Division of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; §§Department of Pediatrics, Texas Children's Hospital, Houston, Texas; and ¶¶Department of Neurosciences, University of California, La Jolla, San Diego, California.
出版信息
Pediatr Infect Dis J. 2017 Aug;36(8):751-757. doi: 10.1097/INF.0000000000001573.
BACKGROUND
Medication adherence is a critical but challenging developmental task for children and adolescents with perinatally acquired HIV (PHIV). Understanding how medication responsibility, executive functions (EFs) and adaptive functioning (AF) influence adherence may help prepare adolescents for transition to adulthood.
METHODS
Participants included PHIV children and adolescents 7-16 years of age enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol, who were prescribed antiretroviral medications. Measures included caregiver report and child self-report measures of adherence, medication responsibility and EF, caregiver report of child AF, examiner-administered tests of EF and processing speed and demographic and health characteristics.
RESULTS
Two hundred fifty-six participants with PHIV (mean age: 12 years old) were 51% female, 80% black and 79% non-Hispanic. Per 7-day recall, 72% were adherent (no missed doses). Children/adolescents self-reported that 22% had sole and 55% had shared medication responsibility. Adjusted logistic models revealed significantly higher odds of adherence with sole caregiver responsibility for medication [odds ratio (OR): 4.10, confidence interval (CI): 1.43-11.8, P = 0.009], child nadir CD4% <15% (OR: 2.26, CI: 1.15-4.43, P = 0.018), better self-reported behavioral regulation (OR: 0.65, CI: 0.44-0.96, P = 0.029) and slower processing speed (OR: 0.54, CI: 0.38-0.77, P < 0.001), adjusting for demographic variables (age, race and caregiver education).
CONCLUSIONS
Among children and adolescents with PHIV, continued caregiver medication management, especially during adolescence, is essential. Although global EF and AF were not significantly associated with adherence, behavioral regulation was. Given that EF and AF develop throughout adolescence, their relationships to adherence should be evaluated longitudinally, especially as youth transition to adulthood and caregiver responsibility diminishes.
背景
对于围产期感染艾滋病毒（PHIV）的儿童和青少年而言，药物依从性是一项关键但具有挑战性的发育任务。了解药物责任、执行功能（EFs）和适应性功能（AF）如何影响依从性，可能有助于青少年为向成年期过渡做好准备。
方法
研究参与者包括7至16岁参加儿科艾滋病毒/艾滋病队列研究青少年主方案的PHIV儿童和青少年，他们正在服用抗逆转录病毒药物。测量指标包括照顾者报告和儿童自我报告的依从性、药物责任和EFs，照顾者报告的儿童AF，由检查者实施的EFs和处理速度测试，以及人口统计学和健康特征。
结果
256名患有PHIV的参与者（平均年龄：12岁）中，51%为女性，80%为黑人，79%为非西班牙裔。根据7天回忆法，72%的人依从性良好（无漏服剂量）。儿童/青少年自我报告称，22%独自负责用药，55%与他人共同负责用药。调整后的逻辑模型显示，独自由照顾者负责用药时依从性的几率显著更高[优势比（OR）：4.10，置信区间（CI）：1.43 - 11.8，P = 0.009]，儿童最低点CD4%<15%（OR：2.26，CI：1.15 - 4.43，P = 0.018），自我报告的行为调节能力更好（OR：0.65，CI：0.44 - 0.96，P = 0.），处理速度较慢（OR：0.54，CI：0.38 - 0.77，P < 0.001），并对人口统计学变量（年龄、种族和照顾者教育程度）进行了调整。
结论
在患有PHIV的儿童和青少年中，照顾者持续进行药物管理至关重要，尤其是在青少年时期。尽管整体EFs和AF与依从性无显著关联，但行为调节能力与之相关。鉴于EFs和AF在整个青少年时期都会发展，应纵向评估它们与依从性的关系，尤其是在青少年向成年期过渡且照顾者责任减少时。
Zotero 插件