Yale University

A randomized comparison of two instruments for measuring self-reported antiretroviral adherence.

TitleA randomized comparison of two instruments for measuring self-reported antiretroviral adherence.
Publication TypeJournal Article
Year of Publication2008
AuthorsMannheimer, S., L. Thackeray, K. Huppler Hullsiek, M. Chesney, E. M. Gardner, A. W. Wu, E. E. Telzak, J. Lawrence, J. Baxter, and G. Friedland
Corporate AuthorsTerry Beirn Community Program for Clinical Research on AIDS
JournalAIDS care
Date Published2008 Feb
KeywordsAdult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, Drug Administration Schedule, Female, Follow-Up Studies, HIV Infections, Humans, Male, Middle Aged, Patient Compliance, Research Design, Self Administration
AbstractA randomised trial compared two instruments for assessing self-reported adherence to antiretroviral medications: (1) a day-by-day recall instrument that elicited the number of missed doses in each of the prior three days (3-day instrument; n=64) and (2) a general recall instrument that elicited an estimate of proportion of pills taken during the prior seven days (7-day instrument; n=70). Adherence was measured at study visits over 12 months among participants in a clinical trial assessing treatment strategies for individuals with virologic failure and multidrug-resistant HIV. Participants had a median (interquartile range) of 133 (41-264) CD4 cells/ml(3) and a median of 10 major HIV resistance mutations at baseline. Mean adherence levels were 90-98% throughout the study. There was a greater trend in the likelihood of 100% adherence when measured by the 3-day versus the 7-day instrument (odds ratio (OR)=1.45; p=0.06). The likelihood of consistent 100% adherence measured by either instrument decreased over time (p<0.001). Participants reporting 100% adherence at more than half of study visits had better virologic and immunologic outcomes at month-12 compared to those reporting 100% adherence at half or fewer visits (HIV RNA decline of 0.96 versus 0.51 log, respectively, p=0.02; and CD4 cell increase of 51.0 versus 17.8 cells, p=0.04). This study demonstrated the utility of the general 7-day recall adherence self-report instrument as well as the 3-day day-by-day recall adherence self-report instrument for measuring antiretroviral adherence. Self-reported adherence was significantly associated with virologic and immunologic outcomes in this population with advanced drug-resistant HIV disease.
Alternate JournalAIDS Care

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