Antiretroviral Therapy Adherence and Viral Suppression in HIV‐Infected Drug Users: Comparison of Self‐Report and Electronic Monitoring

Abstract

To compare electronically monitored (MEMS) with self-reported adherence in drug users, including the impact of adherence on HIV load, we conducted a 6-month observational study of 67 antiretroviral-experienced current and former drug users. Adherence (percentage of doses taken as prescribed) was calculated for both the day and the week preceding each of 6 research visits. Mean self-reported 1-day adherence was 79% (median, 86%), and mean self-reported 1-week adherence was 78% (median, 85%). Mean MEMS 1-day adherence was 57% (median, 52%), and mean MEMS 1-week adherence was 53% (median, 49%). One-day and 1-week estimates were highly correlated (r>.8 for both measures). Both self-reported and MEMS adherence were correlated with concurrent HIV load (r=.43-.60), but the likelihood of achieving virologic suppression was greater if MEMS adherence was high than if self-reported adherence was high. We conclude that self-reported adherence is higher than MEMS adherence, but a strong relationship exists between both measures and virus load. However, electronic monitoring is more sensitive than self-report for the detection of nonadherence and should be used in adherence intervention studies.

Self-report measures of medication adherence behavior: recommendations on optimal use

“…Most evidence shows that medication adherence plays an important role in glycemic control, but many other factors can affect glycemic control besides medicationtaking (e.g., diet, exercise, extent of insulin deficiency, and adequacy of the prescribed regimen), so comparisons of self-report medication adherence measures to the clinical outcome of HbA1c levels should show a modest relationship at best. Expectations regarding the ability of self-report measures to predict clinical outcomes should be set accordingly [2,53] [18,51,54]. A review of type 2 diabetes research found that significant relationships between medication adherence and glycemic control occurred more frequently in studies measuring adherence via prescription refill rather than various self-report measures [18].…”

“…typically indicates that self-report measures have weaker or less consistent relations with clinical outcomes relative to other measures of adherence [18,51,54]. A review of type 2 diabetes research found that significant relationships between medication adherence and glycemic control occurred more frequently in studies measuring adherence via prescription refill rather than various self-report measures [18].…”

“…A review of type 1 diabetes research found that the relation between adherence to diabetes management behaviors and glycemic control in type 1 diabetes showed no overall differences when using either self-reports or blood glucose meter downloads, but studies using self-report measures showed significant heterogeneity in their effect size estimates, whereas meters showed little variability [19]. In HIV research, Arnsten and colleagues [54] concluded that both self-reports and EDM devices show strong correspondence to HIV viral load, but EDMs were more sensitive for detecting nonadherence than self-report. These reports indicate that self-report measures contain value for predicting clinical outcomes, but this value may be limited relative to more precise yet resource-intensive electronic instruments.…”

Voucher reinforcement improves medication adherence in HIV-positive methadone patients: A randomized trial

“…These data are downloaded to a computer using PowerView software (Aardex Ltd.) that stores the information in a database. In this study, we monitored one selected HAART medication as the primary outcome measure of adherence, as research has shown it to be more sensitive than other methods (Arnsten et al, 2001;McNabb et al, 2003). On-time MEMS cap openings were expressed as the percentage of scheduled dosing times when the cap was opened "on-time," defined as taking place in a 4-hour window (2 hours before or after) around the scheduled dosage time, that is, percent observed openings/percent expected openings.…”

An adherence trilogy is essential for long-term HAART success

“…Overall self-reported adherence was higher than MEMS [14,45,46]. However, MEMS adherence was strongly correlated with concurrent viral load [14,[47][48][49][50]. In the paper of Arnsten, the mean self-reported 1-day adherence was 79% compared to electronic monitoring (MEMS) of 52%.…”