Discrepancies between self-reported medication in adherence and indirect measurement adherence among patients undergoing antiretroviral therapy: a systematic review

Abstract

Background: Given the critical importance of medication adherence in HIV/AIDS treatment, this study aims to compare medication adherence measured by self-report (SR) and indirect measurement among antiretroviral therapy (ART) patients, exploring the differences of adherence results measured by different tools.

Methods: We systematically searched PubMed, Embase, and the Cochrane Library to identify all relevant literature published up to November 22, 2023, without language restrictions, reporting adherence to ART measured by both SR and indirect measurement methods, while also analyzing individual and group adherence separately. Discrepancies between SR and indirect measurement results were assessed using the Mann-Whitney U test or Wilcoxon signed-rank test, with correlations evaluated using the Pearson correlation coefficient. Following one-to-one comparisons, meta-epidemiological one-step analysis was conducted, and network meta-analysis techniques were applied to compare results obtained through specific adherence assessment tools reported in the identified articles.

Results: The analysis encompassed 65 original studies involving 13,667 HIV/AIDS patients, leading to 112 one-to-one comparisons between SR and indirect measurement tools. Statistically significant differences were observed between SR and indirect measurement tools regarding both individual and group adherence (P < 0.05), with Pearson correlation coefficients of 0.843 for individual adherence and 0.684 for group adherence. During meta-epidemiological one-step analysis, SR-measured adherence was determined to be 3.94% (95% CI: -4.48-13.44%) higher for individual adherence and 16.14% (95% CI: 0.81-18.84%) higher for group adherence compared to indirectly measured results. Subgroup analysis indicated that factors such as the year of reporting and geographic region appeared to influence the discrepancies between SR and indirect measurements. Furthermore, network meta-analysis revealed that for both individual and group adherence, the results obtained from most SR and indirect measurement tools were higher than those from electronic monitoring devices, with some demonstrating statistical significance (P < 0.05).

Conclusions: The findings underscored the complexity of accurately measuring medication adherence among ART patients. Significant variability was observed across studies, with self-report methods showing a significant tendency towards overestimation. Year of reporting, geographic region, and adherence measurement tools appeared to influence the differences between SR and indirect measurements. Future research should focus on developing and validating integrated adherence measurements that can combine SR data with indirect measures to achieve a more comprehensive understanding of adherence behaviors.

Keywords: AIDS; Antiretroviral therapy; HIV; Medication adherence; Meta-epidemiological one-step analysis; Network meta-analysis; Self-report.

Fig. 1

Flow diagram for study screening and selection process. AHRQ Agency for Healthcare Research and Quality Evaluation Form. AHRQ agency for healthcare research and quality

Fig. 2

Forest plot of differences in the results of different measurement tools for evaluating individual adherence of HIV patients through a network meta-analysis. ACTG AIDS Clinical Trials Group Adherence Questionnaire, EMD electronic monitoring devices, PC pill counting, PR pharmacy refill, Q qustionare, VAS Visual Analog Scale. The numbers following the measurement tools represent the number of days in the recall period for the scale, "i" stands for single-item qualitative measurement

Fig. 3

Forest plot of differences in the results of different measurement tools for evaluating group adherence of HIV patients through a network meta-analysis. ACTG AIDS Clinical Trials Group Adherence Questionnaire, APM appointment record, Bio biological maker, EMD electronic monitoring devices, MMAS-8 Morisky Medication Adherence Scale-8 Items, PC pill counting, PR pharmacy refill, Q qustionare, VAS Visual Analog Scale. The numbers following the measurement tools represent the number of days in the recall period for the scale. "i" stands for single-item qualitative measurement, and "nr" stands for not reported recall period