Estimating HIV Medication Adherence and Persistence: Two Instruments for Clinical and Research Use
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Antiretroviral therapy (ART) requires lifelong daily oral therapy. While patient characteristics associated with suboptimal ART adherence and persistence have been described in cohorts of HIV-infected persons, these factors are poor predictors of individual medication taking behaviors. We aimed to create and test instruments for the estimation of future ART adherence and persistence for clinical and research applications. Following formative work, a battery of 148 items broadly related to HIV infection and treatment was developed and administered to 181 HIV-infected patients. ART adherence and persistence were assessed using electronic monitoring for 3 months. Perceived confidence in medication taking and self-reported barriers to adherence were strongest in predicting non-adherence over time. Barriers to adherence (e.g., affordability, scheduling) were the strongest predictors of non-adherence, as well as 3- and 7-day non-persistence. A ten-item battery for prediction of these outcomes (www.med.unc.edu/ncaidstraining/adherence/for-providers) and a 30-item battery reflective of underlying psychological constructs can help identify and study individuals at risk for suboptimal ART adherence and persistence.
KeywordsAdherence HIV Item response theory Measurement Prediction
This study was supported by a research Grant from Merck & Co., Inc, and the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR), an NIH funded program P30 AI50410. We are grateful to the many service providers and the staff at participating clinics who contributed and the many patients living with HIV infection who generously participated. We thank our dedicated ESTEEM research assistants: Madison Hayes, Katherine Stein, Joseph Murphy, Jazmin Brown, Shawn Jones, and Jasmine Stringer.
Compliance with Ethical Standards
Conflict of interest
The authors have no relevant conflicts of interest to report.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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