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Assessing Antiretroviral Adherence via Electronic Drug Monitoring and Self-Report: An Examination of Key Methodological Issues

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Abstract

We explored methodological issues related to antiretroviral adherence assessment, using 6 months of data collected in a completed intervention trial involving 136 low-income HIV-positive outpatients in the Bronx, NY. Findings suggest that operationalizing adherence as a continuous (versus dichotomous) variable and averaging adherence estimates over multiple assessment points (versus using only one) explains greater variance in HIV-1 RNA viral load (VL). Self-reported estimates provided during a phone interview accounted for similar variance in VL as EDM estimates (R 2 = .17 phone versus .18 EDM). Self-reported adherence was not associated with a standard social desirability measure, and no difference in the accuracy of self-report adherence was observed for assessment periods of 1–3 days. Self-reported poor adherence was more closely associated with EDM adherence estimates than self-reported moderate and high adherence. On average across assessment points, fewer than 4% of participants who reported taking a dose of an incorrect amount of medication.

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Acknowledgments

This work was supported by Stroum Endowed Minority Dissertation Fellowship funding to Dr. Cynthia Pearson, University of Washington Center for AIDS Research Sociobehavioral and Prevention Research Core (P30 AI 27757) funding to Dr. Kurth, and 2 R01 MH58986 to Dr. Simoni.

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Authors and Affiliations

  1. Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA

    Cynthia R. Pearson & Diane P. Martin

  2. Department of Psychology, University of Washington, Seattle, WA, 98105-1525, USA

    Cynthia R. Pearson & Jane M. Simoni

  3. Department of Statistics, University of Washington, Seattle, WA, USA

    Peter Hoff

  4. School of Nursing, University of Washington, Seattle, WA, USA

    Ann E. Kurth

  5. Center for AIDS Research, University of Washington, Seattle, WA, USA

    Ann E. Kurth

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  1. Cynthia R. Pearson
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  2. Jane M. Simoni
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  3. Peter Hoff
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  4. Ann E. Kurth
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Correspondence to Cynthia R. Pearson.

Additional information

Despite hundreds of empirical studies and thousands of papers written about patient adherence and compliance, the question of how best to measure it is still an open one. (Di Matteo, Hays, & Gritz, 1993).

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Pearson, C.R., Simoni, J.M., Hoff, P. et al. Assessing Antiretroviral Adherence via Electronic Drug Monitoring and Self-Report: An Examination of Key Methodological Issues. AIDS Behav 11, 161–173 (2007). https://doi.org/10.1007/s10461-006-9133-3

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