Predictors of Antiretroviral Adherence as Measured by Self-Report,Electronic Monitoring,and Medication Diaries

Abstract

This study reports on the prevalence and predictors of adherence as measured by self-report, medication diaries, and electronic monitoring. A sample of 180 patients receiving human immunodeficiency virus(HIV) antiretroviral therapy were randomized to one of three adherence surveillance methods (electronic monitoring caps, patient medication diaries, no surveillance control group) for 4 weeks, with adherence measured by self-report at study end point; 173 (96%) participants completed the study. Most participants were male (82%), non-white (68%), and unemployed (84%); mean self-reported CD4 count was 406 cells/mm³, and 31% reported having undetectable viral load. The three methods of adherence measurement revealed moderate (electronic monitoring: 80.6%) to high (self-report: 93.7%; diaries: 92.6%) rates of adherence. Although there were differences across adherence measures, variables that were identified as correlates of lower adherence by all three methods included living with others or having a larger household, current symptomatology, and cognitive functioning deficits. This consensus across adherence measures strengthens the validity of these identified predictors and their potential value in informing the development of adherence interventions, as well as increases the validity of the three adherence measures.