{"doi":"10.1186/s12887-025-05939-4","title":"Rates of adherence, adherence measurement, and support services for children and adolescents living with HIV followed in global sites of the International Epidemiology Databases to Evaluate AIDS (IeDEA)","abstract":"INTRODUCTION: Supporting and improving antiretroviral therapy (ART) adherence and preventing the evolution of HIV drug resistance remain major challenges for children and adolescents living with HIV globally. In a large global HIV clinical data consortium, we sought to describe how global HIV care programs measure and support pediatric ART adherence, as well as patient-level measures of adherence. METHODS: We prospectively collected site-level data between June 2014-March 2015 using a site assessment survey and retrospectively examined patient-level data collected during routine clinical care, to provide a comprehensive assessment of pediatric ART adherence across the International Epidemiology Databases to Evaluate AIDS (IeDEA) cohort, in six global regions. All regions capturing patient-level data on adherence by any measure for children living with HIV aged less than 14 years between 2000-2015 were asked to contribute data. ART adherence was conceptualized as a binomial variable of \"good\" (greater than 90%) or \"poor\" (90% or less) adherence per visit. RESULTS: Clinical staff from 180 pediatric sites in 45 countries completed the adherence survey. Clinician adherence assessment (used at 87% of sites) and pharmacy refills (86% of sites) were the most common adherence measurement methods used globally. Counseling focused on adherence was the most commonly available support service, (94% of sites). 28,664 pediatric patients had at least one adherence measurement, to be included for adherence analyses. In East Africa and Southern Africa, higher baseline CD4 counts were associated with a greater likelihood of viral suppression; however, in Central and South America and the Caribbean (CCASAnet) and Asia-Pacific, we did not find a consistent relationship between baseline CD4 count and the likelihood of viral suppression. We found evidence that very young children (< 2 years of age), older children (> 10 years of age), and males were less likely to experience viral suppression in East Africa and Southern Africa. CONCLUSION: These findings indicate that the majority of global pediatric HIV care services routinely measure ART adherence for children living with HIV; however, few sites use objective or validated measures. Identifying subgroups of children and youth at highest risk for non-adherence allows care programs to target those most in need of adherence support or resistance monitoring.","journal":"BMC Pediatrics","year":2025,"id":576661,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9007,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":512364,"name":"Constantin T. Yiannoutsos","orcid":"0000-0001-9014-3651","position":1,"is_corresponding":false},{"id":329431,"name":"Andrew Edmonds","orcid":"0000-0001-6768-0096","position":2,"is_corresponding":false},{"id":445700,"name":"Valériane Leroy","orcid":"0000-0003-3542-8616","position":3,"is_corresponding":false},{"id":315057,"name":"Geoffrey Fatti","orcid":"0000-0002-6467-662X","position":4,"is_corresponding":false},{"id":374397,"name":"Pope Kosalaraksa","orcid":"0000-0003-4450-2398","position":5,"is_corresponding":false},{"id":451368,"name":"Jorge Pinto","orcid":"0000-0003-2987-3238","position":6,"is_corresponding":false},{"id":445697,"name":"Beverly Musick","orcid":"0000-0003-0334-6798","position":7,"is_corresponding":false},{"id":663465,"name":"Winstone Nyandiko","orcid":"0000-0002-7639-9287","position":8,"is_corresponding":false},{"id":752719,"name":"Christelle Twizere","orcid":null,"position":9,"is_corresponding":false},{"id":692618,"name":"Madeleine Amorissani‐Folquet","orcid":"0000-0001-6101-5810","position":10,"is_corresponding":false},{"id":1107946,"name":"Safari Mbewe","orcid":null,"position":11,"is_corresponding":false},{"id":499749,"name":"Fernando Mejía","orcid":"0000-0001-8429-8833","position":12,"is_corresponding":false},{"id":685295,"name":"Michael Scanlon","orcid":"0000-0002-0334-5640","position":13,"is_corresponding":false},{"id":751412,"name":"Roxanne Martin","orcid":"0000-0002-0978-1400","position":14,"is_corresponding":false},{"id":279947,"name":"Kara Wools-Kaloustian","orcid":null,"position":15,"is_corresponding":false},{"id":446492,"name":"IeDEA","orcid":null,"position":16,"is_corresponding":false},{"id":663466,"name":"Rachel Vreeman","orcid":"0000-0001-5460-8204","position":0,"is_corresponding":true}],"reference_count":28,"raw_metadata":null,"created_at":"2026-07-19T02:58:00.620755Z","pmid":"41039293","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}