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. 2012 Jul;26(7):388-94.
doi: 10.1089/apc.2011.0447. Epub 2012 Jun 11.

Approaches to identifying appropriate medication adherence assessments for HIV infected individuals with comorbid bipolar disorder

Jayraan Badiee  1 , Patricia K Riggs, Alexandra S Rooney, Florin Vaida, Igor Grant, J Hampton Atkinson, David J Moore; Hiv Neurobehavioral Research Program (HNRP) Group
Affiliations

Approaches to identifying appropriate medication adherence assessments for HIV infected individuals with comorbid bipolar disorder

Jayraan Badiee et al. AIDS Patient Care STDS. 2012 Jul.

Abstract

Assessing medication adherence in already difficult-to-treat HIV-infected subpopulations presents a unique challenge. The objective of this study was to compare different approaches to assessing medication adherence: (1) electronic medication monitoring, (2) standardized self-report questionnaire, and (3) self-report visual analogue scale, and to determine whether antiretroviral therapy (ART) adherence measures differed for HIV-infected persons with bipolar disorder (HIV+ /BD+) as compared to HIV-infected persons without bipolar disorder (HIV+ /BD-). ART adherence was assessed for 74 HIV-positive participants using the Medication Event Monitoring System (MEMS), AIDS Clinical Trials Group (ACTG) adherence questionnaire, and visual analogue scale (VAS). Participants were classified as adherent or nonadherent on each measure by previously validated cutscores. Correlations and logistic regressions were used to examine associations between adherence measures and demographic and clinical variables. In the HIV+ /BD- group, significant correlations existed between each self-report measure and the MEMS. Males comprised 81% of the study population. Participants averaged 44 years of age and 13 years of education. No significant correlations were found among adherence measures in the HIV+ /BD+ group. Among participants reporting adherence on either self-report measure but classified as nonadherent based on MEMS, 94% had a diagnosis of bipolar disorder. Bipolar disorder was a significant predictor of adherence classification discordance among self-report measures. Our findings suggest that it remains difficult to assess ART adherence among HIV-positive individuals with bipolar disorder. Combined approaches of self-report and objective measures may be the best way to estimate adherence, and may provide the best basis for interventions designed to improve adherence in difficult-to-treat populations.

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Figures

FIG. 1.
FIG. 1.
Proportion deemed adherent based on common cutscores for given measurement tools between HIV+ /BD− and HIV+ /BD+ individuals (MEMS p<0.0001; ACTG p=0.90; VAS p=0.04); error bars denote 95% confidence intervals. BD, bipolar disorder; MEMS, Medication Event Monitoring System; ACTG, AIDS Clinical Trials Group (ACTG) adherence questionnaire; VAS, visual analogue scale.
FIG. 2.
FIG. 2.
Mean adherence percentages by bipolar status.
See this image and copyright information in PMC

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