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Arch Pediatr Adolesc Med. 2003 Mar;157(3):249-55.

Barriers to HAART adherence among human immunodeficiency virus-infected adolescents.

Author information

Health Risk Reduction Projects, Integrated SUbstance Abuse Programs, Department of Psychiatry, University of California, Los Angeles, 90025-3556, USA.



To investigate the barriers to highly active antiretrovial therapy (HAART) adherence among human immunodeficiency virus (HIV)-infected adolescents and to explore the association of barriers and nonadherence.


Structured interviews were conducted to determine the barriers associated with adherence; principal component factor analysis was performed on scores of the 19 barrier variables.


Human immunodeficiency virus-infected adolescents were recruited from 13 US cities into the REACH (Reaching for Excellence in Adolescent Care and Health) Project, the first large-scale disease progression study of HIV-positive adolescents infected through sexual behavior or injection drug use.


Human immunodeficiency virus-infected adolescents in the REACH cohort who were prescribed HAART (N = 114) were included in the analyses.


The main outcome measures were self-report of adherence and barriers to adherence and viral load (HIV-1 RNA level in plasma).


Viral load was significantly associated with self-report of adherence to HAART (P =.02). Only 28.3% of adolescents reported taking all of their prescribed antiretroviral medications in the previous month. Factor analysis of the barriers to adherence indicates there are 2 factors accounting for the largest proportion of the variance: (1) medication-related adverse effects (both physical and psychological) and (2) complications in day-to-day routines.


Adherence was tied closely with daily routine, which supports the assumption that working closely with adolescents to improve their organizational skills may be necessary to improve adherence. Patient-level intervention, provider-level intervention, and health care system modification may all be necessary to improve HIV-infected adolescents' adherence to HAART.

[Indexed for MEDLINE]

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