Diagnostic Value of Different Adherence Measures Using Electronic Monitoring and Virologic Failure as Reference Standards

Abstract

Nonadherence to antiretroviral therapy is a substantial problem in HIV and jeopardizes the success of treatment. Accurate measurement of nonadherence is therefore imperative for good clinical management but no gold standard has been agreed on yet. In a single-center prospective study nonadherence was assessed by electronic monitoring: percentage of doses missed and drug holidays and by three self reports: (1) a visual analogue scale (VAS): percentage of overall doses taken; (2) the Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ): percentage of overall doses missed and drug holidays and (3) the European HIV Treatment Questionnaire (EHTQ): percentage of doses missed and drug holidays for each antiretroviral drug separately. Virologic failure prospectively assessed during 1 year, and electronic monitoring were used as reference standards. Using virologic failure as reference standard, the best results were for (1) the SHCS-AQ after electronic monitoring (sensitivity, 87.5%; specificity, 78.6%); (2) electronic monitoring (sensitivity, 75%; specificity, 85.6%), and (3) the VAS combined with the SHCS-AQ before electronic monitoring (sensitivity, 87.5%; specificity, 58.6%). The sensitivity of the complex EHTQ was less than 50%. Asking simple questions about doses taken or missed is more sensitive than complex questioning about each drug separately. Combining the VAS with the SHCS-AQ seems a feasible nonadherence measure for daily clinical practice. Self-reports perform better after electronic monitoring: their diagnostic value could be lower when given independently.

Influence of Spirituality and Religion on Adherence to Highly Active Antiretroviral Therapy in Adult HIV/AIDS Patients in Calabar, Nigeria

“…The determination of sensitivity and specificity for the VAS and AACTG instruments in this study was not performed because it did not use a "gold standard" such as medication event monitoring system (MEMS) caps, which are used in many studies to assess adherence and make comparisons with self-report measures. However, a study has reported HATASO rabm.scholasticahq.com higher sensitivity and lower specificity with VAS compared to a structured self-report questionnaire such as AACTG [33]. Studies in various settings have reported higher adherence rate with AACTG compared with VAS, similar to findings in this study [34][35][36].…”

Comparison of Adherence Monitoring Tools and Correlation to Virologic Failure in a Pediatric HIV Clinical Trial

“…In addition, when attempting to describe overall adherence, asking simple questions about any missed doses is generally more sensitive than complex questioning about missed doses of each drug in the regimen separately. 19,20 Pill counts are commonly used to assess adherence in clinical practice. Adherence by pill count < 95% for > 3 times at any visit significantly predicted VF in a study of HIV-infected Thai children.…”

Trends in Nonlipid Cardiovascular Disease Risk Factor Management in the Women's Interagency HIV Study and Association with Adherence to Antiretroviral Therapy

“…42 Nonetheless, lifestyle factors and social determinants related to body composition greatly influence CVD prevention, 43 and future studies should focus on these areas. Our measure of ART adherence relies on self-report based on 6-month recall; while self-report has been shown to have validity comparable to more costly monitoring systems such as medication event monitoring systems or unannounced pill counts, 44,45 it may capture behaviors only in a broad sense. We could not define for all participants the severity of hypertension or diabetes before treatment, an important potential influence on the likelihood of controlling these risk factors, which possibly may have differed by HIV serostatus.…”