Responses to a 1 Month Self-Report on Adherence to Antiretroviral Therapy Are Consistent With Electronic Data and Virological Treatment Outcome

AIDS. 2002 Jan 25;16(2):269-77. doi: 10.1097/00002030-200201250-00017.

Abstract

Objectives: Many questionnaires on adherence to antiretroviral therapy are in use, but the validity of patients' responses has not been tested. The Medication Adherence Self-Report Inventory (MASRI) has been developed and tested for its validity against objective measures and treatment outcome.

Design: Prospective study comparing questionnaire responses with MEMS TrackCap (MC, a medication event monitoring system), pill count (PC) and plasma HIV viraemia in a publicly funded specialist HIV clinic.

Participants: Patients self-medicating antiretroviral therapy who were not cognitively impaired and were able to read and understand English.

Results: Mean adherence by MC of the 78 subjects was 92.9% (SE, 1.8%) and by PC 96.8% (SE, 1.4%). Agreement between MC and responses to items about doses missed 1, 2 or 3 days ago was low (kappa = 0.23 (P < 0.03), 0.44 (P < 0.001) and 0.28 (P < 0.01) respectively). This improved when these responses were summated (kappa = 0.46;P < 0.001) and was similar to that for recall of non-adherence over the preceding 2 weeks (kappa = 0.54; P < 0.001). Mean self-reported adherence by visual analogue scale (VAS) over the preceding month was 93.3% (SE, 1.2%). This was strongly associated with both MC (r = 0.63; P < 0.001) and PC (r = 0.75; P < 0.001). On multivariate analysis, the strongest association between a MASRI item and MC was for the VAS. Both the 2 week recall and VAS items were inversely associated with viral load (P = 0.01). There was no association between dose timing (measured MC or questionnaire) or 3 day self-report and viral load.

Conclusions: The MASRI provides a means of measuring patient adherence that is valid when compared with objective measures.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / pharmacology
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Electronic Data Processing
  • Female
  • HIV Infections / blood
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • HIV Infections / virology
  • HIV Protease Inhibitors / pharmacology
  • HIV Protease Inhibitors / therapeutic use*
  • Humans
  • Linear Models
  • Male
  • Patient Compliance / psychology
  • Patient Compliance / statistics & numerical data*
  • Prospective Studies
  • RNA, Viral / blood
  • Reverse Transcriptase Inhibitors / pharmacology
  • Reverse Transcriptase Inhibitors / therapeutic use*
  • Self Administration / psychology
  • Self Administration / statistics & numerical data*
  • Surveys and Questionnaires
  • Time Factors
  • Treatment Outcome
  • Viral Load
  • Viremia

Substances

  • Anti-HIV Agents
  • HIV Protease Inhibitors
  • RNA, Viral
  • Reverse Transcriptase Inhibitors