Self-Report Measures in the Assessment of Antiretroviral Medication Adherence

Kaboré, Lassané; Muntner, Paul; Chamot, Eric; Zinski, Anne; Burkholder, Greer A.; Mugavero, Michael J.

doi:10.1177/2325957414557263

Cited by 45 publications

(31 citation statements)

References 24 publications

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“…The differences may suggest sensitivity of self-report adherence measures to bias, including over reporting or problem recalling real adherence levels. However, consistent with prior studies (Kabore et al, 2015; Simoni et al, 2014), there was no evidence of significant differences or overestimation between the two adherence measures.…”

Section: Resultssupporting

confidence: 88%

“…Respondents were asked to place an “X” inside the box above the point showing the best guess about how much of their current antiretroviral (ARV) medications were taken in the past 30 days. Despite their limitations, patient self-assessments of ART adherence have been shown to perform well (i.e., no evidence of significant overestimation) in comparison with other more objective adherence measures such as pharmacy records (Kabore et al, 2015; Ross-Degnan et al, 2010; Simoni et al, 2014). …”

Section: Methodsmentioning

confidence: 99%

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Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status

Masa

Chowa

Nyirenda

2017

African Journal of AIDS Research

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In Zambia, more people living with HIV now have access to lifesaving antiretroviral therapy than ever before. However, progress in HIV treatment and care has not always resulted in lower mortality. Adherence remains a critical barrier to treatment success. The objective of this study was to examine the barriers and facilitators of antiretroviral therapy adherence, particularly the role of household economic status. The study included a cross-sectional sample of 101 people living with HIV (PLHIV) in two rural communities in eastern Zambia. Adherence was measured using patient self-assessment and pharmacy information. Household economic status included components such as occupation, income, assets, food security, and debt. Multivariable logistic regression was conducted to examine the associations between household economic factors and adherence. Our findings suggest that the role of economic status on adherence appears to be a function of the economic component. Debt and non-farming-related occupation were consistently associated with non-adherence. The association between assets and adherence depends on the type of asset. Owning more transportation-related assets was consistently associated with non-adherence, whereas owning more livestock was associated with self-reported adherence. Additionally, living in a community with fewer economic opportunities was associated with non-adherence. The associations between place of residence and pharmacy refill adherence and between transportation assets and self-reported adherence were statistically significant. Improving adherence requires a multifaceted strategy that addresses the role of economic status as a potential barrier and facilitator. Programmes that provide economic opportunities and life-skills training may help PLHIV to overcome economic, social, and psychological barriers.

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Section: Resultssupporting

confidence: 88%

Section: Methodsmentioning

confidence: 99%

Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status

Masa

Chowa

Nyirenda

2017

African Journal of AIDS Research

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“…Participants may overestimate their adherence to ART because of social desirability bias. However, some evidence suggests that self-reported adherence measures are able to detect poor ART adherence (Kabore et al, 2015 ), and by using a conservative rule of 100% adherent, we may have been able to detect a significant proportion of those who were truly non-adherent. However, future work should assess the association between psychosocial syndemic factors and ART adherence among MSM in Latin America using objective measures, such as viral load, in order to confirm these findings.…”

Section: Discussionmentioning

confidence: 87%

Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America

et al. 2016

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Latin America has some of the highest levels of antiretroviral therapy (ART) coverage of any developing region in the world. Early initiation and optimal adherence to ART are necessary for improved health outcomes and reduction in onward transmission. Previous work has demonstrated the role of psychosocial problems as barriers to uptake and adherence to ART, and recently, a syndemic framework has been applied to the role of multiple psychosocial syndemic factors and adherence to ART, in the USA. However, to our knowledge, these associations have not been investigated outside of the USA, nor in a multi-country context. To address these gaps, we assessed the association between multiple co-occurring psychosocial factors and engagement in HIV-related medical care and adherence to ART among a large, multinational sample of sexually-active HIV-infected men who have sex with men in Latin America.Among the 2020 respondents, 80.7% reported currently receiving HIV-related medical care, 72.3% reported currently receiving ART; among those, 62.5% reported 100% adherence. Compared with experiencing no psychosocial health problems, experiencing five or more psychosocial health problems is associated with 42% lower odds of currently receiving HIVrelated medical care (adjusted odds ratio, aOR = 0.58, 95% CI 0.36, 0.95) and of currently receiving ART (aOR = 0.58, 95% CI 0.38, 0.91). The number of psychosocial health problems experienced was associated with self-reported ART adherence in a dose-response relationship; compared to those with none of the factors, individuals with one syndemic factor had 23% lower odds (aOR = 0.77, 95% CI 0.60, 0.97) and individuals with five or more syndemic factors had 72% lower odds (aOR = 0.28, 95% CI 0.14, 0.55) of reporting being 100% adherent to ART. Addressing co-occurring psychosocial problems as potential barriers to uptake and adherence of ART in Latin America may improve the effectiveness of secondary prevention interventions. ARTICLE HISTORY

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“…However, the association of viral load to both pill count and self-report PCA adherence scores shows that these can be useful indicators of adherence. 31 Second, this analysis mainly examined main effects, and not interactions because of the wide number of potential variables possible for interactions such as study site, HIV risk group, gender, and country. Third, although participants enrolled in the study as a prevention trial, it is possible that some participants’ motivation to join was as a vehicle to gaining ART as treatment for themselves.…”

Section: Discussionmentioning

confidence: 99%

Adherence to Early Antiretroviral Therapy

Safren

Mayer

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background Combination antiretroviral therapy (ART) for HIV-1 infected individuals prevents sexual transmission if viral load is suppressed. Methods Participants were HIV-1 infected partners randomized to early ART (CD4 350-550) in HPTN052 (n=886, median follow-up = 2.1 years), a clinical trial of early ART to prevent sexual transmission of HIV-1 in serodiscordant couples at 13 sites in 9 countries. Adherence was assessed via pill-count (dichotomized at <95%) and via self-report items. Predictors of adherence were mental health and general health perceptions, substance use, binge drinking, social support, sexual behaviors, and demographics. Viral suppression was defined as HIV plasma viral load <400 copies/ml. Adherence counseling and couples counseling about safer sex was provided. Logistic and linear regression models using generalized estimating equation for repeated measurements were employed. Findings Via pill-count, 82% of participants were adherent at 1 month and 83.3% at 1 year. Mental health was the only psychosocial variable associated with adherence (pill-count OR=1.05: 95% CI: 1.00 – 1.11; self-report parameter estimate (b)=0.02, 95% CI: 0.01 –0.04), though regional differences emerged. Pill-count (OR=1.19, 95% CI: 1.10-1.30) and self-report (OR=1.42, 95% CI: 1.14-1.77) adherence were associated with viral suppression. Interpretation While adherence was high among individuals in stable relationships taking ART for prevention, mental health and adherence co-varied. Assessing and intervening on mental health in the context of promoting adherence to ART as prevention should be explored. Adherence and couples counseling, feedback about viral suppression, and/or altruism may also help explain the magnitude of adherence observed.

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Self-Report Measures in the Assessment of Antiretroviral Medication Adherence

Abstract: These data suggest various SRA measures hold clinical value in screening for poor ART adherence.

Cited by 45 publications

References 24 publications

Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status

Barriers and facilitators of antiretroviral therapy adherence in rural Eastern province, Zambia: the role of household economic status

Multiple syndemic psychosocial factors are associated with reduced engagement in HIV care among a multinational, online sample of HIV-infected MSM in Latin America

Adherence to Early Antiretroviral Therapy

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