Date of Award


Document Type


Degree Name

Medical Doctor (MD)

First Advisor

Kaveh Khoshnood, MPH, PhD

Second Advisor

Elizabeth Brooks Claus, MD, PhD


PREDICTORS OF ANTIRETROVIRAL ADHERENCE AMONG HIV INFECTED CHILDREN AND ADOLESCENTS IN HARARE, ZIMBABWE. Jessica R. Berwick and Frances M. Cowan. Regai Dzive Shiri Project, University of Zimbabwe, Harare, Zimbabwe. (Sponsored by Kaveh Khoshnood, School of Public Health, Yale University School of Medicine). Children and adolescents face unique social and psychological barriers to antiretroviral therapy (ART) adherence. We administered a questionnaire to HIV infected Zimbabwean children and adolescents to characterize the social and psychological vulnerabilities that reduce their overall well being, including their ability to adhere to ART therapy. All participants in Zvandiri support groups for HIV infected children and adolescents were recruited to complete the questionnaire. Questionnaires were completed by 229 children and adolescents (median age 14 years (range 6-19); 59% female). Of those currently taking ART, 56% reported fewer than two missed doses per week (86% adherence); nearly a third described missing medications no more than once every two weeks (96% adherence). No association was found between poor adherence and age, mental health status, level of education, poverty, food insecurity, orphaning, having changed household, disclosure of HIV status, or experience of stigma. ART nonadherence rates among HIV infected children and adolescents in Harare, Zimbabwe, are high. Factors that have been presumed to be associated with medication adherence in this population are not found to predict adherence in this study. More data are needed to identify other psychosocial factors that influence adherence, and should be elicited using a combination of adherence measurement tools.


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