Which adherence measure – self‐report, clinician recorded or pharmacy refill – is best able to predict detectable viral load in a public ART programme without routine plasma viral load monitoring?

Abstract

Abstractobjective Combination antiretroviral therapy (cART) suppresses viral replication to an undetectable level if a sufficiently high level of adherence is achieved. We investigated which adherence measurement best distinguishes between patients with and without detectable viral load in a public ART programme without routine plasma viral load monitoring.method We randomly selected 870 patients who started cART between May 2009 and April 2012 in 10 healthcare facilities in Addis Ababa, Ethiopia. Six hundred and sixty-four (76.3%) patients who were retained in HIV care and were receiving cART for at least 6 months were included and 642 had their plasma HIV-1 RNA concentration measured. Patients' adherence to cART was assessed according to self-report, clinician recorded and pharmacy refill measures. Multivariate logistic regression model was fitted to identify the predictors of detectable viremia. Model accuracy was evaluated by computing the area under the receiver operating characteristic (ROC) curve.result A total of 9.2% and 5.5% of the 642 patients had a detectable viral load of ≥40 and ≥400 RNA copies/ml, respectively. In the multivariate analyses, younger age, lower CD4 cell count at cART initiation, being illiterate and widowed, and each of the adherence measures were significantly and independently predictive of having ≥400 RNA copies/ml. The ROC curve showed that these variables altogether had a likelihood of more than 80% to distinguish patients with a plasma viral load of ≥400 RNA copies/ml from those without.conclusion Adherence to cART was remarkably high. Self-report, clinician recorded and pharmacy refill non-adherence were all significantly predictive of detectable viremia. The choice for one of these methods to detect non-adherence and predict a detectable viral load can therefore be based on what is most practical in a particular setting.

Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

“…The six items yielded a reliability score (Cronbach's Alpha coefficient) of 0.69, which indicate high internal consistency. Our measure of adherence, based on self reporting, has been demonstrated to be robust and predictive of virological suppression [14,23] and has been previous validated [24]. A response of yes was coded as "1" and no as "0".…”

“…Also, our measure of adherence is based on self-reporting; thus, adherence level may have been exaggerated due to social desirability bias. Nevertheless, the use of multiple questions to assess adherence offers a more reliable approach to measuring this concept as demonstrated in previous studies [14,28,29].…”

“…Existing evidence suggests that adherence rate decline during the postnatal period after peaking during pregnancy [9][10][11]. Also, studies conducted in Uganda and Zambia suggest that adherence rate is higher among pregnant women compared to breastfeeding women [12][13][14]. Younger age, alcohol and tobacco use, higher parity, and postpartum depression are among the main factors associated with non-adherence to ART [15,16], while disclosure and partner support facilitate adherence [17,18].…”

At‐Risk Alcohol Use is Associated with Antiretroviral Treatment Nonadherence Among Adults Living with HIV/AIDS

“…Nonadherence to ART was determined based on (i) response to part of the self‐report AIDS Clinical Trial Group Questionnaire indicating any missed ART doses in the previous 4 days or (ii) detectable plasma HIV RNA (≥50 copies/ml) (Mekuria et al., ; Nieuwkerk and Oort, ). The viral load assay was performed the same day as the alcohol assessment.…”

Development and Application of the Lincoln Adherence Instrument Record for Assessing Client Adherence to Advice in Dog Behavior Consultations and Success

“…Measures used include pill counts, self-reports, electronic measures, and biological markers (4), with a multi-method approach being frequently advocated, but some of these measures are not feasible in contexts such as animal behavioral therapies (1) where treatment is administered by owners usually at arm’s length from the clinician. Self-reported measures of adherence are often inaccurate with patients often exaggerating adherence levels (24), whereas clinician reports may be a more acceptable method of measuring adherence (25). …”