A review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode = 7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.

Nonadherence in the management of chronic illness is a pervasive clinical challenge. Although researchers have identified multiple correlates of adherence, the field remains relatively atheoretical. The authors propose a cognitive-affective model of medication adherence based on social support theory and research. Structural equation modeling of longitudinal survey data from 136 mainly African American and Puerto Rican men and women with HIV/AIDS provided preliminary support for a modified model. Specifically, baseline data indicated social support was associated with less negative affect and greater spirituality, which, in turn, were associated with self-efficacy to adhere. Self-efficacy to adhere at baseline predicted self-reported adherence at 3 months, which predicted chart-extracted viral load at 6 months. The findings have relevance for theory building, intervention development, and clinical practice.

Objective To determine the relative efficacy of peer support and pager messaging strategies versus usual care to improve medication adherence and clinical outcomes among HIV-positive outpatients initiating or switching to a new highly active antiretroviral therapy regimen. Design A 2 × 2 factorial randomized controlled trial of a 3-month intervention with computer-assisted self-interviews and blood draws administered at baseline, 3, 6, and 9 months. Methods HIV-positive patients at a public HIV specialty clinic in Seattle, WA (N= 224) were randomly assigned to peer support, pager messaging, both strategies, or usual care. The main outcomes were adherence according to self-report and electronic drug monitoring, CD4 count, and HIV-1 RNA viral load. Results Intent-to-treat analyses suggested the peer intervention was associated with greater self-reported adherence at immediate post-intervention. However, these effects were not maintained at follow-up assessment; nor were there significant differences in biological outcomes. The pager intervention, on the other hand, was not associated with greater adherence but did appear to have effects on biological outcomes at post-intervention that were sustained at follow-up. Conclusions Analyses indicate the potential efficacy of peer support but not pager messaging in promoting short-term antiretroviral adherence. Strategies to maintain adherence over time still are needed.

Survey interviews were conducted with a random sample of 50 primarily indigent, African American and Puerto Rican men and women at an outpatient human immunodeficiency virus (HIV) clinic in the Bronx, New York. Analyses revealed a generally high rate of adherence according to self-report data (i.e., on average, participants reported taking 85% of their medications over the last 3 days). However, adherence to the correct number of pills, dosing schedules, and special instructions was more problematic. No sociodemographic or substance use indicators were associated with adherence. Compared to men, women reported higher scores on the Crowne-Marlowe Social Desirability Scale, which were positively correlated with self-reported adherence. "Forgot" (50%) and "felt worse" (46%) were the most common reasons for missed doses. Mediation analyses provided partial support for our proposed model of social support and adherence. Specifically, regression analyses controlling for social desirability indicated that need for social support was positively correlated with acknowledged nonadherence and that this relationship was mediated by self-efficacy and depressive symptomatology.