ObjectivesSelf-report antiretroviral therapy (ART) adherence has been consistently associated with clinical outcomes. This study aims to compare the accuracy of self-report ART adherence measures with varying recall timeframes or item contents to predict virological response.MethodsData from a cross-sectional study among 2146 participants on ART in Guangxi, China were used. Detectable viral load was defined as viral load > 50 copies/ml. Adherence was measured using the number of days on which all doses were taken in the past month (i.e., the “one-month days taken” measure), the number of days on which any dose was missed in the past month (i.e., the “one-month days missed” measure), missed doses over the past 3 days, and missed days over the past weekend. Each adherence measure was dichotomized at an empirically determined cut-off to determine poor vs. good adherence. Accuracy of using each dichotomized adherence measure to predict detectable viral load was assessed by sensitivity, specificity, and the area under the receiver-operating characteristic (AUROC) curve. Logistic regressions were used to calculate the association between poor adherence and detectable viral load.ResultsAll four measures had sensitivity below 10.0%, specificity above 90.0%, and AUROC slightly above 0.50. In univariate logistic regression, detectable viral load was statistically significantly associated with poor adherence determined by the one-month days taken measure (OR = 1.98, 95% CI 1.15–3.42), the 3-day measure (OR = 2.18, 95% CI 1.10–4.34), and the weekend measure (OR = 2.86, 95% CI 1. 54–5.34). After adjusting for covariates, statistically significant association persisted only for the weekend measure (OR = 2.57, 95% CI 1.33–4.99).ConclusionsAdherence measures asking about days on which all doses were taken might work better than items asking about days on which respondents missed their doses, and weekend measures should be included to comprehensively capture adherence behaviors. Further studies looking at intermediate timeframes are also needed to capture patients’ dose-missing patterns that may better predict detectable viral load.
Several methodological gaps exist regarding assessing the relationship between antiretroviral therapy (ART) and mental health. Adopting an "HIV care continuum" perspective, data from a cross-sectional study among 2987 people living with HIV (PLHIV) in Guangxi, China were used to examine the association between ART uptake, ART adherence and mental health. ART uptake status was retrieved from medical records. ART adherence was self-reported by ART users as the number of days on which medications were taken as prescribed over the past month, with good vs. poor adherence defined with a percent adherence cut-off of 90%. Depression, anxiety, and mentalhealth related quality of life were used as mental health indicators. Separate analysis was conducted to assess the impact of ART uptake and ART adherence. Differences in mental health were investigated using multivariate analysis of variance (MANOVA). Multivariate analysis of covariance (MANCOVA) adjusting for propensity scores calculated from socio-demographic, health-related, and psychosocial covariates were further conducted. MANCOVA results showed statistically significant multivariate effects for ART adherence (Wilk's λ = 0.984, F [3, 1885] =10.26, p<0.001) but not ART uptake (Wilk's λ = 0.998, F [3, 2476] =1.67, p=0.17). Post-hoc comparisons with Bonferroni adjustment (α=0.05/3 = 0.0167) showed that among ART users, those with good adherence had lower scores on anxiety (p=0.006) and higher scores on MHS (p=0.007), but no difference was found for depression (p=0.023). As only ART adherence was associated with better mental health among PLHIV, in order to maximize the potential mental health benefits of ART, intervention efforts need to emphasize on treatment adherence.
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