(P127) Facilitators and barriers of pediatric adherence to anti-retroviral treatment in perinatally infected, HIV positive infants

Background: Clinical treatment and maintenance of human immunodeficiency virus (HIV) has developed significantly since the initial diagnoses in 1981. However, women and children, specifically those living in sub-Saharan Africa, continue to be disproportionately affected by rates of infection. In 2021, 1.7 million children aged zero to 14 were living with HIV, and approximately 54% of these children had access to life saving anti-retroviral medication (ART). It is important to think critically about the intersections of biology, anthropology, epidemiology, and sociology to understand the systemic factors associated with the persistence of HIV in particular populations across the globe.

Methods: We conducted a scoping review to systematically identify and categorize the multiple, interacting influences on adherence to ART for an infantile patient. We searched databases for articles in February 2022 and included articles published in the prior 5 years that involved factors shaping adherence behaviors. We used Bronfenbrenner’s Social-Ecological Model (SEM) as a conceptual framework to analyze the multi-level influences on adherence. The paper follows the structure of a previous 2009 review to present updated information on adherence for the pediatric, perinatally infected infant and caregiver (Haberer and Mellins 2009).

Results: Our search strategy yielded 72 articles. Given the timeline of uptake in Africa of the 2016 WHO-recommended ART treatment in newborns, we excluded all articles published prior to 2016. Information from the remaining 44 articles is presented in the format of the SEM. The four sections for categorizing factors on adherence are: Individual/Caregiver, Family Outside the Caregiver, Extra-Familial, and Social-Cultural. These sections each reveal diverse layers of facilitators and barriers to adherence to ART for the perinatally infected, pediatric patient. Disclosure of infant’s status and the subsequent social support surrounding the caregiver and infant are two main factors related to adherence.

Conclusions: The review demonstrates the need for a multifaceted, interdisciplinary approach to address adherence in similar populations. The SEM framework revealed multiple levels of influences on adherence that are amenable to public health intervention strategies. This review identifies gaps of knowledge in the existing literature on pediatric adherence to illuminate the need for future, comprehensive research regarding these key populations.