Therapy Adherence and Highly Active Antiretroviral Therapy: Comparison of Three Sources of Information

Abstract

With the advent of the highly active antiretroviral therapy (HAART), adherence became one of the key issues within the behavioral management of the treatment of human immunodeficiency virus (HIV) infection. One of the central limitations in studying adherence to HAART is that usually one has to rely on self-reported measures of adherence. In this study, we combine information on adherence from several sources. We rely not only on the self-report of patients but also on the perception of adherence reported by the patient's designated most significant other. As a third measure, we use the evaluation of adherence by the physician in charge of the treatment of the patient, and finally, we also use human immunodeficiency type 1 (HIV-1) RNA levels. In order to explain variations in adherence among patients, we used the health belief model, adherence-specific social support, and the satisfaction of patients with the health care provider–patient relation. The sample consists of 86 persons (78.6% males). The mean age was 41.2 years (standard deviation, 9.1 years). Correlations between the measures are moderate to weak. These results indicate that a substantial amount of error is present when evaluating patient adherence. However, it is not known which measure is the best indicator of adherence. If we use a theoretical framework such as the health belief model as standard to evaluate variations in adherence, then our findings point in the direction of using adherence as perceived by the medical staff.