Background-Self-report measures of medication adherence are inexpensive and minimally intrusive. However, the validity of self-reported adherence is compromised by recall errors for missed doses and socially desirable responding.Method-Examined the convergent validity of two self-report adherence measures administered by computerized interview: (a) recall of missed doses and (b) a single item visual analogue rating scale (VAS). Adherence was also monitored using unannounced phone-based pill counts which served as an objective benchmark.Results-The VAS obtained adherence estimates that paralleled unannounced pill counts. In contrast, self-reported recall of missed medications consistently over-estimated adherence. Correlations with participant characteristics also suggested that the computer administered VAS was less influenced by response biases than self-reported recall of missed medication doses. Conclusions-A single item VAS offers an inexpensive and valid method of assessing medication adherence that may be useful in clinical as well as research settings.Monitoring medication adherence poses multiple challenges in clinical and research settings. Several strategies are available for measuring medication adherence, each with their own relative advantages and disadvantages. Table 1 presents the most common methods used for assessing medication adherence in research and clinical practice. While electronic medication monitoring systems offer considerable measurement precision, they are costly and can interfere with commonly used adherence improvement strategies, particularly pill boxes and pocketed dose containers [1,2]. Alternatively, unannounced pill counts provide accurate information about medications adherence [3][4][5]. Once again, however, accurate estimates of adherence come at a cost, and unannounced pill counts require significant staff time and patient burden.In contrast to objective measures of medication adherence, self-report assessments are inexpensive and carry minimal patient burden. State of the science reviews have concluded that self-reported adherence assessments correlate with objective measures including electronic monitoring systems and self-report methods are associated with health indicators, most critically HIV viral load [6]. The most widely used self-report adherence measure was developed by the AIDS Clinical Trials Group (ACTG) network [7,8]. The ACTG interview asks patients to recall how many doses of their medications they missed in the past week using day-by-day retrospective recall. Self-reported recall of medications missed (SR-recall) is easily integrated into clinical interviews and is relatively non-intrusive. However, selfreport adherence measures rely on memory and tend to over-estimate adherence [9]. Asking individuals to recall an event in which they forgot to take their medications has obvious cognitive limitations and can be influenced by socially desirable responding because people with HIV are told routinely to never miss a dose of their medications.An alterna...

BACKGROUND: Unannounced pill counts conducted in patients' homes is a valid objective method for monitoring medication adherence that is unfortunately costly and often impractical. Conducting unannounced pill counts by telephone may be a viable alternative for objectively assessing medication adherence. PURPOSE:To test an unannounced pill count assessment of adherence conducted by telephone. METHODS: HIV-positive men and women (N=77) inAtlanta GA completed an unannounced telephonebased pill count immediately followed by a pill count conducted in an unannounced home visit. RESULTS:A high degree of concordance was observed between phone and home-based number of pills counted (Intraclass correlation, ICC= .997, 95% CI .995-.998, P<.001) and percent of pills taken (ICC= .990, 95% CI .986-.992, P<.001). Concordance between adherence above/below 90% and phone/home counts was 95%, Kappa coefficient = .995. Concordance between pill counts was not influenced by participant education or health literacy and was maintained when the data were censored to remove higher levels of adherence. Analyses of discordant pill counts found the most common source of error resulted from overcounted doses in pillboxes on the telephone.CONCLUSIONS: Unannounced phone-based pill counts offer an economically and logistically feasible objective method for monitoring medication adherence.

South Africa is in the midst of one of the world's most devastating HIV/AIDS epidemics and there is a well documented association between violence against women and HIV transmission. Interventions that target men and integrate HIV prevention with gender-based violence prevention may demonstrate synergistic effects. A quasi-experimental field intervention trial was conducted with two communities randomly assigned to receive either: (a) a five session integrated intervention designed to simultaneously reduce gender-based violence (GBV) and HIV risk behaviors (N=242) or (b) a single 3-hour alcohol and HIV risk reduction session (N=233). Men were followed for 1, 3, and 6-months post intervention with 90% retention. Results indicated that the GBV/HIV intervention reduced negative attitudes toward women in the short term and reduced violence against women in longer term. Men in the GBV/HIV intervention also increased their talking with sex partners about condoms and were more likely to have been tested for HIV at the follow-ups. There were few differences between conditions on any HIV transmission risk reduction behavioral outcomes. Further research is needed to examine the potential synergistic effects of alcohol use, gender violence, and HIV prevention interventions.

Affordable and effective antiretroviral therapy (ART) adherence interventions are needed for many patients to promote positive treatment outcomes and prevent viral resistance. We conducted a two-arm randomized trial (n = 40 men and women receiving and less than 95% adherent to ART) to test a single office session followed by four biweekly cell phone counseling sessions that were grounded in behavioral self-management model of medication adherence using data from phone-based unannounced pill counts to provide feedback-guided adherence strategies. The control condition received usual care and matched office and cell phone/pill count contacts. Participants were baseline assessed and followed with biweekly unannounced pill counts and 4-month from baseline computerized interviews (39/40 retained). Results showed that the self-regulation counseling delivered by cell phone demonstrated significant improvements in adherence compared to the control condition; adherence improved from 87% of pills taken at baseline to 94% adherence 4 months after baseline, p < 0.01. The observed effect sizes ranged from moderate (d = 0.45) to large (d = 0.80). Gains in adherence were paralleled with increased self-efficacy (p < 0.05) and use of behavioral strategies for ART adherence (p < 0.05). We conclude that the outcomes from this test of concept trial warrant further research on cell phone-delivered self-regulation counseling in a larger and more rigorous trial.

HIV/AIDS is concentrated among the inner-city poor and poverty may directly interfere with HIV treatment. This study examined food insufficiency in relation to HIV-related health and treatment. A sample of 344 men and women living with HIV/ AIDS in Atlanta, Georgia completed measures of food security, health, and HIV disease progression and treatment. HIV treatment adherence was monitored using unannounced pill counts. Results showed that half of people living with HIV/AIDS in this study lacked sufficient food, and food insufficiency was associated with multiple indicators of poor health, including higher HIV viral loads, lower CD4 cell counts, and poorer treatment adherence. Adjusted analyses showed that food insufficiency predicted HIV treatment non-adherence over and above years of education, employment status, income, housing, depression, social support, and non-alcohol substance use. Hunger and food insecurity are prevalent among people living with HIV/AIDS, and food insufficiency is closely related to multiple HIV-related health indicators, particularly medication adherence. Interventions that provide consistent and sustained meals to people living with HIV/AIDS are urgently needed.