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Measuring adherence to highly active antiretroviral therapy: Implications for research and practice

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Abstract

Highly active antiretroviral therapy (HAART) has radically changed the course of HIV disease, producing substantial reductions in both HIV-related morbidity and mortality. However, the complexity of the typical daily HAART regimen is substantial, and high levels of adherence are essential for complete and long-term viral suppression and the avoidance of drug resistance. The complexity of HAART has made the assessment of medication adherence of paramount importance. Even though various methods are in use, each measures only a subset of adherence behaviors, and each measure has limited predictive validity. Given the individual and public health concerns associated with adherence to HAART, there is a need for the continued development and validation of measures of medication adherence.

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References and Recommended Reading

  1. Hogg RS, Yip B, Kully C, et al.: Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ 1999, 160:659–665.

    PubMed  CAS  Google Scholar 

  2. Hammer SM, Squires KE, Hughes MD, et al.: A controlled trial of two nucleoside analogues plus indinavir in persons with human immunodeficiency virus infection and CD4 cell counts of 200 per cubic millimeter or less. AIDS Clinical Trials Group 320 Study Team. N Engl J Med 1997, 337:725–733.

    Article  PubMed  CAS  Google Scholar 

  3. Rabkin JG, Chesney M: Treatment adherence to HIV medications: The Achilles heel of the new therapeutics. In New HIV therapies: Psychological and public health implications. Edited by Ostrow D, Kalichman S. New York: Plenum Press; 1999.

    Google Scholar 

  4. Friedland GH, Williams A: Attaining higher goals in HIV treatment: the central importance of adherence. AIDS 1999, 13(Suppl 1):S61–72.

    PubMed  Google Scholar 

  5. Hecht FM: Measuring HIV treatment adherence in clinical practice. AIDS Clin Care 1998, 10:57–59.

    Article  PubMed  CAS  Google Scholar 

  6. Imrie A, Beveridge A, Genn W, et al.: Transmission of human immunodeficiency virus type 1 resistant to nevirapine and zidovudine. Sydney Primary HIV Infection Study Group. J Infect Dis 1997, 175:1502–1506.

    Article  PubMed  CAS  Google Scholar 

  7. Wagner JH, Justice AS, Chesney M, et al.: Patient- and provider-reported adherence: toward a clinically useful approach to measuring antiretroviral adherence. J Clin Epidemiol 2001, 54(Suppl 1):S91–98.

    Article  PubMed  Google Scholar 

  8. Hugen PW, Langebeek N, Burger DM, et al.: Assessment of adherence to HIV protease inhibitors: comparison and combination of various methods, including MEMS (electronic monitoring), patient and nurse report, and therapeutic drug monitoring. J Acquir Immune Defic Syndr 2002, 30:324–334.

    PubMed  CAS  Google Scholar 

  9. LiuH, et al.: A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med 2001, 134:968–977. This study employs one of the more rigorous comparisons of several different measures of adherence. As well, the authors demonstrated the predictive validity of a composite adherence score.

    PubMed  CAS  Google Scholar 

  10. NieuwkerkPT, Oort FJ: Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: a meta-analysis. J Acquir Immune Defic Syndr 2005, 38:445–448. This study is among the first to employ a meta-analytic technique to evaluate a particular approach to adherence measurement. The study is also important due to its confirmation of the utility of self-report measures of adherence.

    Article  PubMed  Google Scholar 

  11. Miller LG, Hays RD: Measuring adherence to antiretroviral medications in clinical trials. HIV Clin Trials 2000, 1:36–46.

    Article  PubMed  CAS  Google Scholar 

  12. Deeks SG: Treatment of antiretorviral drug-resistant HIV-1 infection. Lancet 2003, 362:2002–2011.

    Article  PubMed  CAS  Google Scholar 

  13. Park DC, Kidder DP: Prospective memory and medication adherence. In Prospective Memory: Theory and Applications. Edited by Brandimonte M, Einstein GO, McDaniel MA. Mahwah, NJ: Erlbaum; 1996:369–390.

    Google Scholar 

  14. Hubley AM, Zumbo BD: A dialectic on validity: where have we been and where are we going? J Gen Psychol 1996, 123:207–215.

    Article  Google Scholar 

  15. BangsbergDR, Hecht FM, Clague H, et al.: Provider assessment of adherence to HIV antiretroviral therapy. J Acquir Immune Defic Syndr 2001, 26:435–442. This study reveals the inaccuracy of service provider estimates of patient adherence and points to the need for improved measurement of adherence in clinical settings. The study also indicates that assessment of adherence over multiple short intervals may help to improve adherence assessment in clinical settings.

    PubMed  CAS  Google Scholar 

  16. Gordillo V, Amo J, Soriano V, Gonzalez-Lahoz J: Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 1999, 13:1763–1769.

    Article  PubMed  CAS  Google Scholar 

  17. Kastrissios H, Suarez JR, Katzenstein D, et al.: Characterizing patterns of drug-taking behavior with a multiple drug regimen in an AIDS clinical trial. AIDS 1998, 12:2295–2303.

    Article  PubMed  CAS  Google Scholar 

  18. Bangsberg DR, Hecht FM, Charlebois ED, et al.: Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS 2000, 14:357–366.

    Article  PubMed  CAS  Google Scholar 

  19. Pullar T, Kumar S, Tindall H, Feely M: Time to stop counting the tablets? Clin Pharmacol Ther 1989, 46:163–168.

    Article  PubMed  CAS  Google Scholar 

  20. Cinti SK: Adherence to antiretrovirals in HIV disease. AIDS Read 2000, 10:709–717.

    PubMed  CAS  Google Scholar 

  21. Wagner GJ, Rabkin JG: Measuring medication adherence: are missed doses reported more accurately then perfect adherence? AIDS Care 2000, 12:405–408.

    Article  PubMed  CAS  Google Scholar 

  22. Paterson DL, Potoski B, Capitano B: Measurement of adherence to antiretroviral medications. J Acquir Immune Defic Syndr 2002, 31(Suppl 3):S103–106.

    PubMed  Google Scholar 

  23. Paterson DL, Swindells S, Mohr J, et al.: Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000, 133:21–30.

    PubMed  CAS  Google Scholar 

  24. Arnsten JH, Demas PA, Farzadegan H, et al.: Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis 2001, 33:1417–1423.

    Article  PubMed  CAS  Google Scholar 

  25. Gross R, Bilker WB, Friedman HM, Strom BL: Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. AIDS 2001, 15:2109–2117.

    Article  PubMed  CAS  Google Scholar 

  26. Farley J, Hines S, Musk A, et al.: Assessment of adherence to antiviral therapy in HIV-infected children using the Medication Event Monitoring System, pharmacy refill, provider assessment, caregiver self-report, and appointment keeping. J Acquir Immune Defic Syndr 2003, 33:211 -218.

    Article  PubMed  Google Scholar 

  27. Walsh JC, Mandalia S, Gazzard BG: Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS 2002, 16:269–277.

    Article  PubMed  Google Scholar 

  28. Vanhove GF, Schapiro JM, Winters MA, et al.: Patient compliance and drug failure in protease inhibitor monotherapy. JAMA 1996, 276:1955–1956.

    Article  PubMed  CAS  Google Scholar 

  29. Wagner GJ, Rabkin JG: Measuring medication adherence: is assessment of missed doses sufficient? AIDS 1999, 13:2491–2492.

    Article  PubMed  CAS  Google Scholar 

  30. Chesney MA, Morin M, Sherr L: Adherence to HIV combination therapy. Soc Sci Med 2000, 50:1599–1605.

    Article  PubMed  CAS  Google Scholar 

  31. Grossberg R, Zhang Y, Gross R: A time-to-prescription-refill measure of antiretroviral adherence predicted changes in viral load in HIV. J Clin Epidemiol 2004, 57:1107–1110.

    Article  PubMed  Google Scholar 

  32. Steiner JF, Prochazka AV: The assessment of refill compliance using pharmacy records: methods, validity, and applications. J Clin Epidemiol 1997, 50:105–116.

    Article  PubMed  CAS  Google Scholar 

  33. Low-Beer S, Yip B, O’Shaughnessy MV, et al.: Adherence to triple therapy and viral load response. J Acquir Immune Defic Syndr 2000, 23:360–361.

    PubMed  CAS  Google Scholar 

  34. Wood E, Hogg RS, Yip B, et al.: Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 × 10(9) cells/L. Ann Intern Med 2003, 139:810–816.

    PubMed  Google Scholar 

  35. Wood E, Montaner JS, Yip B, et al.: Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. CMAJ 2003, 169:656–661.

    PubMed  Google Scholar 

  36. Palepu A, Tybdall M, Yip B, et al.: Impaired virologic response to highly active antiretroviral therapy associated with ongoing injection drug use. J Acquir Immune Defic Syndr 2003, 32:522–526.

    Article  PubMed  Google Scholar 

  37. Gifford AL, Bormann JE, Shively MJ, et al.: Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. J Acquir Immune Defic Syndr 2000, 23:386–395.

    PubMed  CAS  Google Scholar 

  38. Murphy DA, Sarr M, Durako SJ, et al.: Barriers to HAART adherence among human immunodeficiency virus-infected adolescents. Arch Pediatr Adolesc Med 2003, 157:249–255.

    Article  PubMed  Google Scholar 

  39. Murri R, Ammassari A, Gallicano K, et al.: Patient-reported nonadherence to HAART is related to protease inhibitor levels. J Acquir Immune Defic Syndr 2000, 4:123–128.

    Google Scholar 

  40. Duran S, Solas C, Spire B, et al.: "Do HIV-infected injecting drug users over-report adherence to highly active antiretroviral therapy?" A comparison between patients’ self-reports and serum protease inhibitor concentrations in the French Manif 2000 cohort study. AIDS 2001, 15:1075–1077.

    Article  PubMed  CAS  Google Scholar 

  41. Tuldra A, Fumaz CR, Ferrer MJ, et al.: Prospective randomized two-arm controlled study to determine the efficacy of a specific intervention to improve long-term adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2000, 25:221–228.

    Article  PubMed  CAS  Google Scholar 

  42. Maggiolo F, Ravasio L, Ripamonti D, et al.: Similar adherence rates favor different virologic outcomes for patients treated with nonnucleoside analogues or protease inhibitors. Clin Infect Dis 2005, 40:158–163.

    Article  PubMed  CAS  Google Scholar 

  43. Chesney MA, Ickovics J, Hecht FM, et al.: Adherence: a necessity for successful HIV combination therapy. AIDS 1999, 13(Suppl A):S271–278.

    PubMed  Google Scholar 

  44. Joslyn S, Loftus E, McNoughton A, Powers J: Memory for memory. Mem Cognit 2001, 29:789–797.

    PubMed  CAS  Google Scholar 

  45. Morris PE: The validity of subjective reports on memory. In Everyday memory actions and absent-mindedness, Edited by Morris PE, Harris JE. London: Academic Press; 1984.

    Google Scholar 

  46. Schacter DL: The seven sins of memory: Insights from psychology and cognitive neuroscience. Am Psychol 1999, 54:182–203.

    Article  PubMed  CAS  Google Scholar 

  47. Schwartz N: Self-reports: How the questions shape the answers. Am Psychol 1999, 54:93–105.

    Article  Google Scholar 

  48. Schacter DL, Dodson CS: Misattribution, false recognition and the sins of memory. Philos Trans R Soc Lond B Biol Sci 2001, 356:1385–1393.

    Article  PubMed  CAS  Google Scholar 

  49. Williams AB: Adherence to highly active antiretroviral therapy. Nurs Clin North Am 1999, 34:113–129.

    PubMed  CAS  Google Scholar 

  50. Alcoba M, Cuevas MJ, Perez-Simon MR, et al.: Assessment of adherence to triple antiretroviral treatment including indinavir: role of the determination of plasma levels of indinavir. J Acquir Immune Defic Syndr 2003, 33:253–258.

    Article  PubMed  Google Scholar 

  51. Bangsberg DR, Bronstone A, Chesney MA, Hecht FM: Computer-assisted self-interviewing (CASI) to improve provider assessment of adherence in routine clinical practice. J Acquir Immune Defic Syndr 2002, 31(Suppl 3):S107–111.

    PubMed  Google Scholar 

  52. Kerr T, Palepu A, Barness G, et al.: Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver. Antivir Ther 2004, 9:407–414.

    PubMed  Google Scholar 

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  1. British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, V6Z 1Y6, Vancouver, British Columbia, Canada

    Thomas Kerr PhD

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  1. Thomas Kerr PhD
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  2. John Walsh PhD
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  3. Elisa Lloyd-Smith BSc
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  4. Evan Wood PhD
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Kerr, T., Walsh, J., Lloyd-Smith, E. et al. Measuring adherence to highly active antiretroviral therapy: Implications for research and practice. Curr HIV/AIDS Rep 2, 200–205 (2005). https://doi.org/10.1007/s11904-005-0017-3

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  • DOI: https://doi.org/10.1007/s11904-005-0017-3

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