title: Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring.
abstract: To compare electronically monitored (MEMS) with self-reported adherence in drug users, including the impact of adherence on HIV load, we conducted a 6-month observational study of 67 antiretroviral-experienced current and former drug users. Adherence (percentage of doses taken as prescribed) was calculated for both the day and the week preceding each of 6 research visits. Mean self-reported 1-day adherence was 79% (median, 86%), and mean self-reported 1-week adherence was 78% (median, 85%). Mean MEMS 1-day adherence was 57% (median, 52%), and mean MEMS 1-week adherence was 53% (median, 49%). One-day and 1-week estimates were highly correlated (r>.8 for both measures). Both self-reported and MEMS adherence were correlated with concurrent HIV load (r=.43-.60), but the likelihood of achieving virologic suppression was greater if MEMS adherence was high than if self-reported adherence was high. We conclude that self-reported adherence is higher than MEMS adherence, but a strong relationship exists between both measures and virus load. However, electronic monitoring is more sensitive than self-report for the detection of nonadherence and should be used in adherence intervention studies.
authors.affiliation: AIDS Research Program, Department of Epidemiology and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York 10467, USA. jarnsten@montefiore.org
authors.forename: J H
authors.initials: JH
authors.lastname: Arnsten
authors.forename: P A
authors.initials: PA
authors.lastname: Demas
authors.forename: H
authors.initials: H
authors.lastname: Farzadegan
authors.forename: R W
authors.initials: RW
authors.lastname: Grant
authors.forename: M N
authors.initials: MN
authors.lastname: Gourevitch
authors.forename: C J
authors.initials: CJ
authors.lastname: Chang
authors.forename: D
authors.initials: D
authors.lastname: Buono
authors.forename: H
authors.initials: H
authors.lastname: Eckholdt
authors.forename: A A
authors.initials: AA
authors.lastname: Howard
authors.forename: E E
authors.initials: EE
authors.lastname: Schoenbaum
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016903:Drug Monitoring; D004581:Electronics; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D012650:Self Disclosure; D019966:Substance-Related Disorders / Q000150:complications*; D011795:Surveys and Questionnaires; D019562:Viral Load