Accuracy of measures for antiretroviral adherence in people living with HIV

Smith, Rhodine; Villanueva, Gemma; Probyn, Katrin; Sguassero, Yanina; Ford, Nathan; Orrell, Catherine; Cohen, Karen; Richardson, Marty; Leeflang, Mariska; Hine, Paul

doi:10.1002/14651858.cd013080.pub2

Cited by 20 publications

(19 citation statements)

References 95 publications

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“…These measures reflected primary (prescription filled) and secondary adherence (medication taken as directed) [ 55 ]. Assessing adherence is useful in research to understand engagement behaviour [ 160 ] and for individual management: particularly identifying the need for and directing interventions before virological failure is established [ 161 ], and for rationalizing expensive genotypic resistance testing for people failing second‐line ART [ 79 , 150 ]. These measures need to be conducted specifically to evaluate adherence, making them less suited to routine programme monitoring.…”

Section: Resultsmentioning

confidence: 99%

“…The generally poor ability of adherence measures to detect viral non‐suppression was demonstrated in a recent Cochrane review, which found a wide variation in sensitivity and specificity across measures [ 161 ]. Adherence measures can also be influenced by the particular drug [ 137 ], body weight, genetics, metabolism [ 75 , 76 ] and “white coat adherence” (temporary improvement in adherence prior to a clinical visit) [ 15 , 137 ].…”

Section: Resultsmentioning

confidence: 99%

“…These measures, however, require the collection of multiple pieces of information, are more complex to calculate, may obscure issues with individual engagement dimensions when combining them and may not always improve the accuracy of the measurement [ 161 ]. Thus, the actual additional benefit needs to be balanced with complexity and feasibility when evaluating multiple dimensions in a single measure.…”

Section: Resultsmentioning

confidence: 99%

“…While combinations improved sensitivity in some cases, this did not substantially improve the association with outcomes, adding complexity without fully overcoming individual measures' limitations [16,122]. This was also demonstrated by a recent Cochrane review that found that the sensitivity of composite measures of adherence ranged from 10% to 100%, and specificity from 49% to 100% [161]. It may be most feasible to use simple measures with moderate association with outcomes and interpret them within their limitations [4].…”

Section: Alternative Approaches To Current Measures Of Engagementmentioning

confidence: 99%

“…Measuring multiple dimensions of engagement can help to evaluate engagement more comprehensively, and may offer a simple approach to flag issues with engagement: if engagement is not optimal, individual dimensions can then be evaluated. These measures, however, require the collection of multiple pieces of information, are more complex to calculate, may obscure issues with individual engagement dimensions when combining them and may not always improve the accuracy of the measurement [161]. Thus, the actual additional benefit needs to be balanced with complexity and feasibility when evaluating multiple dimensions in a single measure.…”

Section: Multi-dimensional Engagementmentioning

confidence: 99%

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Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

et al. 2022

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Introduction:Engagement with HIV care is a multi-dimensional, dynamic process, critical to maintaining successful treatment outcomes. However, measures of engagement are not standardized nor comprehensive. This undermines our understanding of the scope of challenges with engagement and whether interventions have an impact, complicating patient and programmelevel decision-making. This study identified and characterized measures of engagement to support more consistent and comprehensive evaluation. Methods: We conducted a scoping study to systematically categorize measures the health system could use to evaluate engagement with HIV care for those on antiretroviral treatment. Key terms were used to search literature databases (Embase, PsychINFO, Ovid Global-Health, PubMed, Scopus, CINAHL, Cochrane and the World Health Organization Index Medicus), Google Scholar and stakeholder-identified manuscripts, ultimately including English evidence published from sub-Saharan Africa from 2014 to 2021. Measures were extracted, organized, then reviewed with key stakeholders. Results and discussion: We screened 14,885 titles/abstracts, included 118 full-texts and identified 110 measures of engagement, categorized into three engagement dimensions ("retention," "adherence" and "active self-management"), a combination category ("multi-dimensional engagement") and "treatment outcomes" category (e.g. viral load as an end-result reflecting that engagement occurred). Retention reflected status in care, continuity of attendance and visit timing. Adherence was assessed by a variety of measures categorized into primary (prescription not filled) and secondary measures (medication not taken as directed). Active self-management reflected involvement in care and self-management. Three overarching use cases were identified: research to make recommendations, routine monitoring for quality improvement and strategic decision-making and assessment of individual patients. Conclusions: Heterogeneity in conceptualizing engagement with HIV care is reflected by the broad range of measures identified and the lack of consensus on "gold-standard" indicators. This review organized metrics into five categories based on the dimensions of engagement; further work could identify a standardized, minimum set of measures useful for comprehensive evaluation of engagement for different use cases. In the interim, measurement of engagement could be advanced through the assessment of multiple categories for a more thorough evaluation, conducting sensitivity analyses with commonly used measures for more comparable outputs and using longitudinal measures to evaluate engagement patterns. This could improve research, programme evaluation and nuanced assessment of individual patient engagement in HIV care.

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