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Abstract
BackgroundAntiretroviral adherence is essential to HIV treatment efficacy. Various self-reported measures are commonly used for assessing antiretroviral adherence. Limited data are available regarding the validity of those self-reported measures in comparison with long-term objective biomarkers of adherence measures such as hair measures.MethodsSelf-reported adherence (frequency, percentage, and visual analog scale [VAS]) and hair tenofovir concentration were evaluated at a single time point from 268 people living with HIV in China. The responses to each of three self-reported measures were converted into percentage and then dichotomized as “optimal” (100%) vs. “suboptimal” (less than 100%) adherence. Two composite adherence scores (CAS) were created from the three self-reported measures: (1) an overall adherence was the average percentage of the three self-reported measures; (2) responses were termed optimal adherence if participants reporting optimal adherence in all three self-reported measures, while were termed suboptimal adherence. Hair tenofovir concentration was also dichotomized as “optimal” (above the limit of quantitation, 36 pg/mg) vs. “suboptimal” adherence (blow 36 pg/mg). Spearman correlation, kappa statistics, and logistic regression analysis were used to calculate the correlations, agreements, and predictions of self-reported measures with hair measure, respectively.ResultsOverall adherence, but any of the three self-reported adherence, was correlated with hair tenofovir concentration (r = 0.13, p < 0.05). Self-reported optimal adherence in VAS and CAS measures were agreed with and predicted optimal adherence assessed by hair measure (Kappa = 0.107, adjusted OR = 1.88, 95% CI 1.03–3.45; Kappa = 0.109, adjusted OR = 1.80, 95% CI 1.02–3.18; all p < 0.05, respectively).ConclusionVAS may be a good individual self-reported measure for antiretroviral adherence, and CAS may be a good composite self-reported measure for antiretroviral adherence.
Highlights
Antiretroviral adherence is essential to Human immunodeficiency virus (HIV) treatment efficacy
Of the participants (Table 1), 69.4% were men, 70.1% were of Han ethnicity, 79.5% were married, 77.2% were full or part-time employed, and 93.7% were on tenofovir disoproxil fumarate (TDF)-based first-line antiretroviral therapy (ART)
Spearman correlation statistics showed that only overall adherence, but any of the three self-reported adherence was correlated with hair tenofovir concentration (r = 0.13, p < 0.05)
Summary
Antiretroviral adherence is essential to HIV treatment efficacy. Despite the increased availability of antiretroviral medications, HIV-related morbidity, mortality, and new infection rate continually increased over the years in China from 2004 to 2016 [1]. Both clinical trials and cohort studies have. Suboptimal adherence severely undercuts antiretroviral effectiveness and places PLHIV at risk for virologic failure, increases the risk of onward HIV transmission, and limits the impact of HIV treatment resources [5, 6]. Detecting and addressing suboptimal adherence to antiretroviral is an essential component of HIV treatment and management in China and other countries. One of the challenges is how to assess antiretroviral adherence accurately
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