The benefits of antiretroviral (ARV) medications are well established in adults and also work effectively in children to control the immune suppression of the HIV virus and to reduce viral replication. However, drugs can respond differently in children, making regular monitoring a must.  Effective ARV therapy slows disease progression and restores and/or preserves immune function, enabling children to more readily combat bacterial and viral infections that could develop into opportunistic infections.  Since parents administer medications for pediatric patients, health care team members must address barriers to adherence facing both their pediatric patients and, perhaps more importantly, parents.

Formula: The number of pediatric patients prescribed ARV therapy (with at least one HIV primary care visit in the past 12 months) who have had a documented assessment of adherence to ARV therapy in the past four months, divided by the total number of pediatric patients prescribed ARV therapy (with at least one HIV primary care visit in the past 12 months). Multiply by 100 to calculate percent.

For further explanation of this indicator and/or criteria for exclusions, please view indicator definitions on the National HIVQUAL Project’s website.

Increase the percentage of pediatric patients on ARV therapy who are assessed for adherence to their ARV regimen every four months to 100 percent.

Every month (or at the frequency established by your quality improvement effort), review a sample of pediatric patients with at least one HIV primary care visit in the past year who are prescribed ARV therapy to identify those patients who have had a documented assessment of adherence to their ARV therapy regimen.

Documented Adherence Assessments must meet the following criteria:

• Assessement completed by appropriate members of the HIV care team, such as the clinician, nursing team, case manager, etc.
• Includes documented quantification of ARV medication adherence, using one of two accepted methods:
  • Percentages (“patient is 85 percent adherent”)
  • Number of medications taken during a specific time period (“patient took seven out of 10 medications in the last three days”)

Count the number of pediatric patients with at least one HIV primary care visit in the past 12 months who have had a documented adherence assessment in the past four months. Divide by the total number of pediatric patients with at least one HIV primary care visit in the 12 months.  Multiply by 100 to calculate percent.

The National HIVQUAL Project’s Minimum Sample Table will help you determine the number of records in your sample. Research Randomizer can generate a random number series to help you select which records to review.