A measure to assess HIV treatment readiness among adolescents and young adults

ABSTRACT

HIV infections among adolescents and young adults continue to grow and clinical guidelines recommend the immediate start of life-saving antiretroviral therapy (ART). Unfortunately, suboptimal medication adherence among youth is common and can lead to poorer health outcomes as well as onward transmission of HIV to sexual partners. Clinical tools to assess treatment readiness are needed and can assist with adherence intervention strategies for youth. An assessment tool that we previously developed, the HIV Treatment Readiness Measure (HTRM), was administered to 595 HIV-positive youth ages 13–24 recruited from adolescent medicine clinics in the United States. Participants were followed for a minimum of 6 months and had to have at least one viral load test completed to be included in this analysis. The HTRM demonstrated high internal consistency (Chronbach’s alpha = 0.86). For participants currently on ART at study entry, higher overall treatment readiness scores predicted future viral suppression (OR 1.52). Individual scores on three of the measure’s factors (Psychosocial Issues, Connection with Care, and HIV Medication Beliefs) were also significant predictors of viral suppression. For those participants not on ART at study entry, the HIV Medication Beliefs factor significantly predicted who would eventually start ART (OR 2.26) but overall treatment readiness scores did not predict viral suppression in that group.

KEYWORDS:

• HIV
• medication adherence
• adolescents
• youth

Acknowledgments

This research was supported by The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) from the National Institutes of Health [U01HD040533 and U01HD040474] through the National Institute of Child Health and Human Development (Kapogiannis, Lee), with supplemental funding from the National Institutes on Drug Abuse (Davenny, Kahana) and Mental Health (Brouwers, Allison). Network, scientific and logistical support was provided by the ATN Coordinating Center (Wilson, Partlow) at the University of Alabama at Birmingham. Network operations and data management support was provided by the ATN Data and Operations center at Westat, Inc. (Korelitz, Driver).

Clinics were located in the following locations: Los Angeles, California; Washington, DC; Baltimore, Maryland; Boston, Massachusetts; Chicago, Illinois; Philadelphia, Pennsylvania; New York City, New York; New Orleans, Louisiana; Memphis, Tennessee; Miami, Florida; Tampa, Florida; Detroit, Michigan; Denver, Colorado; and Houston, Texas. We are greatly appreciative to all of the adolescents and young adults who participated in this study. We also acknowledge the contribution of the investigators and staff at the following sites that participated in this study: University of South Florida, Tampa (Emmanuel, Lujan-Zilbermann, Julian), Children’s Hospital of Los Angeles (Belzer, Flores, Tucker), Children’s National Medical Center (D’Angelo, Hagler, Trexler), Children’s Hospital of Philadelphia (Douglas, Tanney, DiBenedetto), John H. Stroger Jr. Hospital of Cook County and the Ruth M. Rothstein CORE Center (Martinez, Bojan, Jackson), Montefiore Medical Center (Futterman, Enriquez-Bruce, Campos), Tulane University Health Sciences Center (Abdalian, Kozina, Baker), University of Miami School of Medicine (Friedman, Maturo, Major-Wilson), St. Jude’s Children’s Research Hospital (Flynn, Dillard), Baylor College of Medicine (Paul, Calles, Cooper), Wayne State University (Secord, Cromer, Green-Jones), Johns Hopkins University School of Medicine (Agwu, Anderson, Park), The Fenway Institute – Boston (Mayer, George, Dormitzer), and University of Colorado, Denver (Reirden, Hahn, Witte).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development [U01HD040533 and U01HD040474].