Conselho Nacional de Ciência e Tecnologia (CNPQ), Process No 305

Conselho Nacional de Ciência e Tecnologia (CNPQ), Process No. 305691/2006-6. The authors declare no conflicts of interest. “
“In Brazil, 13,758 cases of perinatally-acquired human immunodeficiency virus (HIV) infection were reported as of July 2013.1 Access to combined antiretroviral therapy (cART)

has changed the course of HIV disease among Brazilian perinatally-infected children.2 Sustained adherence to therapy Crizotinib clinical trial is the most important determinant of successful treatment and is especially challenging among HIV-infected children and adolescents due to reasons such as dependency on caregivers, attitudes of defiance/denial, and delay in diagnosis disclosure to Neratinib mouse children.3, 4 and 5 This study’s aim was to evaluate treatment adherence among perinatally HIV-infected children and adolescents based on a biomedical (viral suppression) and a behavioral (cART missed doses) outcome, and to explore possible barriers to satisfactory adherence among the Brazilian population. This was a cross-sectional study conducted in five Brazilian centers, each located in one of the five Brazilian macro-regions. Perinatally HIV-infected children and adolescents (0 to 18 years)

on cART for at least eight weeks were eligible. Retrievable laboratory evaluations within six months of the study’s inception were recorded. Study participation was offered as patients attended regular clinic visits with their legal guardians. Study centers have routine adherence support

initiatives that include individual and familiar counseling and group activities; these strategies were not modified during study enrollment. After signing the informed consent, caregivers and adolescents answered structured questionnaires that included sociodemographic information, number of missed doses of cART in the last three days, and the short version of the World Health Organization (WHO) questionnaire for quality of life (WHOQOL-BREF).6 Adherence assessment was peformed by trained healthcare workers with caregivers whenever Paclitaxel the patient was a child (< 13 years), and directly with adolescents. All caregivers answered the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST).7 Anxiety and depression were assessed among caregivers and adolescents using the Hospital Anxiety and Depression Scale (HADS).8 Medical records were reviewed aiming to collect data, including: acquired immunodeficiency syndrome (AIDS) defining diagnosis, previous hospitalizations, CD4 + T lymphocyte cell counts, HIV viral load, and information about the reason for initial HIV test (symptomatic children vs. HIV-exposed children screened in the context of family screening). Pharmacy records were electronically available at every clinical center and routine dispensing was scheduled to occur on a monthly basis.

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