{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T12:40:18Z","timestamp":1759408818541,"version":"build-2065373602"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T00:00:00Z","timestamp":1759363200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AI069911","U01AI096299","U01AI069919","U01AI069924","U01AI069907","U01AI069923"],"award-info":[{"award-number":["U01AI069911","U01AI096299","U01AI069919","U01AI069924","U01AI069907","U01AI069923"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pediatr"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>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\u00a0years between 2000\u20132015 were asked to contribute data. ART adherence was conceptualized as a binomial variable of \u201cgood\u201d (greater than 90%) or \u201cpoor\u201d (90% or less) adherence per visit.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>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\u2013Pacific, we did not find a consistent relationship between baseline CD4 count and the likelihood of viral suppression. We found evidence that very young children (&lt;\u20092\u00a0years of age), older children (&gt;\u200910\u00a0years of age), and males were less likely to experience viral suppression in East Africa and Southern Africa.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12887-025-05939-4","type":"journal-article","created":{"date-parts":[[2025,10,2]],"date-time":"2025-10-02T11:58:17Z","timestamp":1759406297000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"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)"],"prefix":"10.1186","volume":"25","author":[{"given":"Rachel C.","family":"Vreeman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantin T.","family":"Yiannoutsos","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Edmonds","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Val\u00e9riane","family":"Leroy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"Fatti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pope","family":"Kosalaraksa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beverly","family":"Musick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Winstone","family":"Nyandiko","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christelle","family":"Twizere","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madeleine","family":"Amorissani-Folquet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Safari","family":"Mbewe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Mejia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Scanlon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roxanne","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kara","family":"Wools-Kaloustian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"IeDEA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,10,2]]},"reference":[{"key":"5939_CR1","first-page":"2021","volume-title":"confronting inequalities: lessons for pandemic responses from 40 years of AIDS","author":"Global AIDS updates","year":"2021","unstructured":"Global AIDS updates. confronting inequalities: lessons for pandemic responses from 40 years of AIDS. 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These data were approved for use by the local institutional review boards in each of the IeDEA countries included in the analysis and consent requirements were deferred to the local institutional review boards. As the patient-level data was collected from routine patient care, consent was not required from either parents\/caregivers or from the child and youth participants.Due to the large number of participating sites in IeDEA, we are unable to provide all approving IRBs and ethical committees along with this submission at this time. We are able to provide the approvals for the East Africa region, which is the leading and coordinating site for this site assessment: Indiana University Institutional Review Board:\u2014IRB# 1105005574'Regional East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium'and\u2014IRB # 1105005572'International Epidemiologic Databases to Evaluate AIDS (IeDEA), East Africa: Proposal for Data Extraction and Analysis for the Initial Projects'. The patient-related data presented here are based on retrospective deidentified information collected on a routine basis in sites participating in the IeDEA consortium. These data were approved for use by the local institutional review boards in each of the IeDEA countries included in the analysis and consent requirements were deferred to the local institutional review boards. As the patient-level data were collected from routine patient care, consent was not required. All sites and IeDEA regional coordinating centres also had Institutional Review Board approvals in place permitting the collection of site-level data for the survey.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not Applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"706"}}