Multiple self-report measures of antiretroviral adherence correlated in Sierra Leone, but did they agree?

Abstract

In resource-poor settings, studies validating multiple self-report measures of adherence are limited and do not include data from West Africa. We prospectively assessed the associations between multiple self-report measures of adherence in 58 patients receiving antiretroviral therapy. Self-report measures included a 30-day visual analog scale, 30-day qualitative single-item measure, Adult AIDS Clinical Trial Group 4-day recall, and 3-level categorical 7-day qualitative measure. Unannounced pill count was the objective measure. Spearman's rho correlation coefficients, Bland-Altman plots, and receiver operator curve analyses were performed. Median and mean adherence by pill count were 81.8% and 78.6%, respectively. All self-report measures had either intermediate or high correlation with the pill count, and the 7-day measure had the highest level of correlation with pill count (r = 0.72). All self-report measures demonstrated good agreement when mean pill count adherence was greater than 90%. All but the 7-day measure posed challenges to patient understanding and administration of the measure. In this sample of participants that displayed largely suboptimal adherence, the 7-day measure was preferable, but all self-report measures demonstrated relatively good agreement with the objective criterion pill count measure and are adequate for clinical use in settings such as Sierra Leone.

Nonadherence is Associated with Lack of HIV-Related Knowledge

“…25 We found that many were illiterate which is also reported in other African settings. 26 When comparing the adherent with the nonadherent participants, none of the demographic variables differed significantly between groups. This may indicate that being illiterate is not a predictor of nonadherence, and this has also been found in other studies.…”

Evaluation of a community-based ART programme after tapering home visits in rural Sierra Leone: a 24-month retrospective study

“…While we measured adherence to ART for our programme participants throughout the study period, we only measured adherence to ART for a sub-set of individuals receiving standard of care during a three-month period. Additional details of this study are published elsewhere and focus on the adherence to ART for those individuals who were only receiving standard of care (Kelly et al., 2013 ). In this study, we focused on adherence measurement with unannounced pill counts for our study groups (standard of care and community-based ART) over a three-month period ( Table 1 ).…”