Self-report of current and prior antiretroviral drug use in comparison to the medical record among HIV-infected patients receiving primary HIV care

Abstract

Objective: Patient antiretroviral (ARV) therapy knowledge is essential for regimen adherence, successful therapeutic response, and minimization of resistance evolution. Moreover, a complete and accurate patient ARV history is needed to construct efficacious and tolerable future regimens. In this study we assessed the ability of HIV-infected patients receiving care in a university infectious diseases clinic to accurately recall current and past ARVs.

Methods: A convenience sample (n = 205) of UNC HIV Clinical Cohort participants (n = 1840) completed a comprehensive in-person interview. Patients were asked about current and ever ARV use and were provided proprietary and generic ARV names and photographs. Self-reported sensitivity for current and ever ARV use (proportion that correctly identified all recorded ARVs), was calculated using the medical record as the gold standard.

Results: One hundred and eighty-five patients had received ARVs at some point after enrollment in the cohort study (ever users). For current ARV use (n = 138), self-reported sensitivity was 63% (95% CI: 54-71). For ever use (n = 185), sensitivity was 18% (95% CI: 13-24).

Conclusion: Self-reported cumulative ARV use is not accurate. Since HIV-infected patients are prescribed a number of medications over their treatment course, it is necessary to develop new medication reconciliation techniques that are not dependent on patient memory or knowledge in order to improve patient outcomes.

Figure 1

Population mean (solid line) and corresponding 95% confidence intervals (dashed line) of self-reported accuracy (number of correct self-reported ARVs also in the clinical record divided by the number of ARVs in the clinical record) by number of ARVs patients were taking at the time of the interview (current) and all ARVs recorded in the medical record at the time of the interview (ever)