1. Caregiver Reported Missed Doses of Antiretroviral Therapy in HIV-Infected Children in Western Kenya Michael L. Scanlon 1,2 ; Winstone M. Nyandiko 2,3 ; Wanzhu Tu 1 ; Hai Liu 1 ; James E. Slaven 1 ; Sarah E. Wiehe 1 ; Thomas S. Inui 1,2,3 ; Samuel O. Ayaya 2,3 ; Rachel C. Vreeman 1,2,3 1 Indiana University School of Medicine, Indianapolis, IN, USA 2 Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya 3 School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya

2. Objectives & Methods Objective: To evaluate caregiver-reported missed doses as an adherence measurement strategy for HIV-infected children in care through a large HIV treatment program in Kenya Methods: Six-month prospective cohort study following 191 caregiver-child dyads Monthly visits with study personnel who asked caregivers, “In the last 30 days, how many doses of HIV medicine has your child missed?” Children’s nevirapine or efavirenz in bottles with Medication Event Monitoring Systems (MEMS®) for electronic dose monitoring Analyses: Used receiver operating characteristic (ROC) curves and multivariate logistic regression using MEMS® as adherence reference standard

3. Results & Conclusions Results: Caregiver report performed poorly as indicator of non-adherence with low sensitivity and C-statistics MEMS® Non- Adherence Thresholds SensSpecArea Under Curve <100%.252.962.605 <90%.337.903.624 <80%.368.863.623 Table 1. ROC Results Conclusions : Caregivers significantly underestimated their child’s missed doses Caregiver underestimates of non-adherence may reflect lack of knowledge about child’s daily medication intake Several factors associated with caregivers underestimating child’s missed doses: Child’s older age (OR 1.3, 95%CI 1.1- 1.6) More people help give ART (OR 2.1, 95%CI 1.2-3.6) Caregiver employed outside home (OR 2.6, 95%CI 1.3-5.2) Child on EFV (vs. NVP) (OR 3.2, 95%CI 1.4-7.8) ????

4. Questions and Acknowledgements Special thanks to: AMPATH clinicians and nurses CAMP study personnel And most of all to the children and families who donated their time and effort that made this study possible