{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T22:10:28Z","timestamp":1785363028693,"version":"3.55.0"},"reference-count":29,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T00:00:00Z","timestamp":1608163200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007137","name":"Texas Children\u2019s Hospital","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100007137","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>This study identified factors associated with adherence to a 6-month isoniazid preventive therapy (IPT) course among adolescents and children living with HIV. Forty adolescents living with HIV and 48 primary caregivers of children living with HIV completed a Likert-based survey to measure respondent opinions regarding access to care, quality of care, preferred regimens, perceived stigma, and confidence in self-efficacy. Sociodemographic data were collected and adherence measured as the average of pill counts obtained while on IPT. The rates of suboptimal adherence (&lt; 95% adherent) were 22.5% among adolescents and 37.5% among the children of primary caregivers. Univariate logistic regression was used to model the change in the odds of suboptimal adherence. Independent factors associated with suboptimal adherence among adolescents included age, education level, the cost of coming to clinic, stigma from community members, and two variables relating to self-efficacy. Among primary caregivers, child age, concerns about stigma, and location preference for meeting a community-health worker were associated with suboptimal adherence. To determine whether these combined factors contributed different information to the prediction of suboptimal adherence, a risk score containing these predictors was constructed for each group. The risk score had an AUC of 0.87 (95% CI: 0.76, 0.99) among adolescents and an AUC of 0.76 (95% CI: 0.62, 0.90), among primary caregivers suggesting that these variables may have complementary predictive utility. The heterogeneous scope and associations of these variables in different populations suggests that interventions aiming to increase optimal adherence will need to be tailored to specific populations and multifaceted in nature. Ideally interventions should address both long-established barriers to adherence such as cost of transportation to attend clinic and more nuanced psychosocial barriers such as perceived community stigma and confidence in self-efficacy.<\/jats:p>","DOI":"10.1371\/journal.pone.0243713","type":"journal-article","created":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T20:29:39Z","timestamp":1608236979000},"page":"e0243713","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Predictors of suboptimal adherence to isoniazid preventive therapy among adolescents and children living with HIV"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5283-4697","authenticated-orcid":true,"given":"Alexander W.","family":"Kay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3398-6710","authenticated-orcid":true,"given":"Neil","family":"Thivalapill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Skinner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gloria Sisi","family":"Dube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nomathemba","family":"Dlamini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bulisile","family":"Mzileni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia","family":"Fuentes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Ustero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1303-2154","authenticated-orcid":true,"given":"Lisa V.","family":"Adams","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M.","family":"Mandalakas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,12,17]]},"reference":[{"key":"pone.0243713.ref001","unstructured":"World Health Organization. The End TB Strategy. 2015. https:\/\/www.who.int\/tb\/strategy\/End_TB_Strategy.pdf?ua=1"},{"key":"pone.0243713.ref002","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1016\/S0140-6736(15)00323-2","article-title":"Controlling the seedbeds of tuberculosis: diagnosis and treatment of tuberculosis infection","volume":"386","author":"MX Rangaka","year":"2015","journal-title":"Lancet"},{"key":"pone.0243713.ref003","unstructured":"World Health Organization. Recommendations for investigating contacts of persons with infectious tuberculosis in low- and middle-income countries. 2012. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/77741\/9789241504492_eng.pdf;jsessionid=7FB785AB189B6CC80AF8652D3FF2822E?sequence=1"},{"key":"pone.0243713.ref004","unstructured":"World Health Organization. Latent tuberculosis infection: updated and consolidated guidelines for programmatic management. World Health Organization; Geneva; 2018. Report No.: Licence: CC BY-NC-SA 3.0 IGO. https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/260233\/9789241550239-eng.pdf;jsessionid=6BC23E4FCFFB99E5F9A2265A1FD322F8?sequence=1"},{"key":"pone.0243713.ref005","unstructured":"World Health Organization. Global Tuberculosis Report 2020. World Health Organization; 2020."},{"key":"pone.0243713.ref006","doi-asserted-by":"crossref","first-page":"1264","DOI":"10.1111\/j.1365-3156.2012.03053.x","article-title":"Preventive therapy in children exposed to Mycobacterium tuberculosis: problems and solutions","volume":"17","author":"ME Rutherford","year":"2012","journal-title":"Trop Med Int Health"},{"key":"pone.0243713.ref007","doi-asserted-by":"crossref","first-page":"e1001105","DOI":"10.1371\/journal.pmed.1001105","article-title":"Closing the Policy-Practice Gap in the Management of Child Contacts of Tuberculosis Cases in Developing Countries","volume":"8","author":"PC Hill","year":"2011","journal-title":"PLoS Med"},{"key":"pone.0243713.ref008","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2334-14-91","article-title":"Efficacy of isoniazid prophylactic therapy in prevention of tuberculosis in children:a meta\\textendashanalysis","volume":"14","author":"J Ayieko","year":"2014","journal-title":"BMC Infect Dis"},{"key":"pone.0243713.ref009","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1086\/520983","article-title":"The effectiveness of a 9-month regimen of isoniazid alone versus 3- and 4-month regimens of isoniazid plus rifampin for treatment of latent tuberculosis infection in children: results of an 11-year randomized study","volume":"45","author":"NP Spyridis","year":"2007","journal-title":"Clin Infect Dis"},{"key":"pone.0243713.ref010","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1001\/jamapediatrics.2014.3158","article-title":"Treatment for preventing tuberculosis in children and adolescents: a randomized clinical trial of a 3-month, 12-dose regimen of a combination of rifapentine and isoniazid","volume":"169","author":"ME Villarino","year":"2015","journal-title":"JAMA Pediatr"},{"key":"pone.0243713.ref011","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1056\/NEJMoa1714284","article-title":"Safety and Side Effects of Rifampin versus Isoniazid in Children","volume":"379","author":"T Diallo","year":"2018","journal-title":"N Engl J Med"},{"key":"pone.0243713.ref012","doi-asserted-by":"crossref","first-page":"e80803","DOI":"10.1371\/journal.pone.0080803","article-title":"Does an isoniazid prophylaxis register improve tuberculosis contact management in South African children?","volume":"8","author":"N van Soelen","year":"2013","journal-title":"PLoS One"},{"key":"pone.0243713.ref013","first-page":"650","article-title":"Recording isoniazid preventive therapy delivery to children: operational challenges","volume":"14","author":"SS Van Wyk","year":"2010","journal-title":"Int J Tuberc Lung Dis"},{"issue":"Suppl 3","key":"pone.0243713.ref014","doi-asserted-by":"crossref","first-page":"S297","DOI":"10.1097\/QAI.0000000000000497","article-title":"Use of isoniazid preventive therapy for tuberculosis prophylaxis among people living with HIV\/AIDS: a review of the literature","volume":"68","author":"MA Briggs","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0243713.ref015","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1186\/s12879-020-05471-z","article-title":"Successful implementation of isoniazid preventive therapy at a pediatric HIV clinic in Tanzania","volume":"20","author":"OF Hunter","year":"2020","journal-title":"BMC Infect Dis"},{"key":"pone.0243713.ref016","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1186\/s12879-020-05011-9","article-title":"Factors affecting uptake and completion of isoniazid preventive therapy among HIV-infected children at a national referral hospital, Kenya: a mixed quantitative and qualitative study","volume":"20","author":"SK Ngugi","year":"2020","journal-title":"BMC Infect Dis"},{"key":"pone.0243713.ref017","doi-asserted-by":"crossref","first-page":"175","DOI":"10.5588\/ijtld.12.0230","article-title":"Pasting together the preventive therapy puzzle","volume":"17","author":"D Skinner","year":"2013","journal-title":"Int J Tuberc Lung Dis"},{"key":"pone.0243713.ref018","doi-asserted-by":"crossref","first-page":"191","DOI":"10.5588\/pha.13.0010","article-title":"It\u2019s hard work, but it\u2019s worth it: the task of keeping children adherent to isoniazid preventive therapy","volume":"3","author":"D Skinner","year":"2013","journal-title":"Public Health Action"},{"key":"pone.0243713.ref019","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1097\/QAD.0000000000000791","article-title":"High completion of isoniazid preventive therapy among HIV-infected children and adults in Kinshasa, Democratic Republic of Congo","volume":"29","author":"M Yotebieng","year":"2015","journal-title":"AIDS"},{"key":"pone.0243713.ref020","first-page":"1","article-title":"Acceptability and adherence to Isoniazid preventive therapy in HIV-infected patients clinically screened for latent tuberculosis in Dar es Salaam, Tanzania","author":"GA Shayo","year":"2015","journal-title":"BMC Infect Dis"},{"key":"pone.0243713.ref021","doi-asserted-by":"crossref","first-page":"24","DOI":"10.5588\/pha.18.0040","article-title":"When prevention is dangerous: perceptions of isoniazid preventive therapy in KwaZulu-Natal, South Africa","volume":"9","author":"J Boffa","year":"2019","journal-title":"Public Health Action"},{"key":"pone.0243713.ref022","doi-asserted-by":"crossref","first-page":"20049","DOI":"10.7448\/IAS.18.1.20049","article-title":"Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review","volume":"18","author":"OA Adejumo","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"Suppl 3","key":"pone.0243713.ref023","doi-asserted-by":"crossref","first-page":"S123","DOI":"10.1097\/00126334-200212153-00007","article-title":"Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature","volume":"31","author":"A Ammassari","year":"2002","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0243713.ref024","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/QAI.0000000000000728","article-title":"Time and Money: The True Costs of Health Care Utilization for Patients Receiving \u201cFree\u201d HIV\/Tuberculosis Care and Treatment in Rural KwaZulu-Natal","volume":"70","author":"N Chimbindi","year":"2015","journal-title":"J Acquir Immune Defic Syndr"},{"key":"pone.0243713.ref025","first-page":"1","article-title":"High self-reported non-adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors","volume":"20","author":"MH Kim","year":"2017","journal-title":"J Int AIDS Soc"},{"key":"pone.0243713.ref026","doi-asserted-by":"crossref","first-page":"e25176","DOI":"10.1002\/jia2.25176","article-title":"STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa","volume":"21","author":"L Cluver","year":"2018","journal-title":"J Int AIDS Soc"},{"key":"pone.0243713.ref027","doi-asserted-by":"crossref","first-page":"e264","DOI":"10.1016\/S2214-109X(19)30526-1","article-title":"Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster-randomised controlled trial","volume":"8","author":"W Mavhu","year":"2020","journal-title":"Lancet Glob Health"},{"key":"pone.0243713.ref028","doi-asserted-by":"crossref","first-page":"1708","DOI":"10.1038\/s41591-018-0224-2","article-title":"A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary tuberculosis","volume":"24","author":"MZ Imperial","year":"2018","journal-title":"Nat Med"},{"key":"pone.0243713.ref029","doi-asserted-by":"crossref","first-page":"e1002884","DOI":"10.1371\/journal.pmed.1002884","article-title":"The importance of adherence in tuberculosis treatment clinical trials and its relevance in explanatory and pragmatic trials","volume":"16","author":"A Vernon","year":"2019","journal-title":"PLoS Med"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243713","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,12,17]],"date-time":"2020-12-17T20:29:54Z","timestamp":1608236994000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0243713"}},"subtitle":[],"editor":[{"given":"Lawrence","family":"Palinkas","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,12,17]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2020,12,17]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0243713","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,12,17]]}}}