1. Factors Associated with Adherence to Therapy Using Medication Event Monitoring Systems (MEMS®) 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 ; 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 College of Health Sciences, Moi University, Eldoret, Kenya

2. Objective and Study Design OBJECTIVE To investigate relationship between Kenyan children’s ART adherence and clinical, demographic, and social factors METHODS Prospective cohort study following 191 HIV-infected children, ages 0-13, on first-line ART through AMPATH program in western Kenya Monthly comprehensive adherence assessments for 6 months Medication Event Monitoring Systems (MEMS®) electronic monitors Caregivers completed detailed monthly adherence questionnaires Blood samples taken twice (months 3 and 6) to measure CD4 ANALYSES Univariate and multivariate ordinal regression analyses of factors associated with MEMS® adherence ANCOVA to assess relationship between MEMS® adherence and CD4%

3. RESULTS Mean age 8.2 years (SD 3.3) On ART for mean of 2.3 years (SD 1.9) Multiple child and caregiver factors significantly associated with lower MEMS® adherence CD4% significantly higher for MEMS® adherent children at month 6 (p=0.02) but not at month 3 (p=.08 ) Variables Odds Ratio (95%CI) Child’s younger age1.2 (1.1-1.4) Child being female2.3 (1.1-4.7) WHO stage (3 or 4)2.5 (1.2-5.2) Child knows HIV status3.1 (1.1-8.6) Caregiver is mother2.2 (1.2-4.0) Caregiver employed2.6 (1.3-5.1) Difficulties giving ART2.8 (1.5-5.2) Food insecurity2.6 (1.4-4.8) No in-home piped water2.1 (1.1-3.7) Factors Associated with Lower MEMS® Adherence