Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management

Abstract

A review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode = 7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.

Fig. 1

Association is between (a) adherence and VL suppression or (b) nonadherence and VL increase or rebound. Excludes 4 studies that showed statistically significant associations due to overly-wide confidence intervals (Barroso et al., 2003) or because the association was reported differently (e.g., nonadherence as protective from VL suppression) and could not be re-calculated from published data (Cingolani et al., 2002; LeMoing et al., 2002; Trotta et al., 2003)

Fig. 2

Recommended items for assessing self-reported antiretroviral adherence Notes: ^aBased on Golin et al. (2002); ^bBased on Wash, Mandalia, and Gazzard (2002). An exact percentage can be calculated by measuring the distance from 0 to mark in cm or inches; ^cBased on Knobel et al. (2002).