title: Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome.
abstract: OBJECTIVE
  Many questionnaires on adherence to antiretroviral therapy are in use, but the validity of patients' responses has not been tested. The Medication Adherence Self-Report Inventory (MASRI) has been developed and tested for its validity against objective measures and treatment outcome.
  
  
  METHODS
  Prospective study comparing questionnaire responses with MEMS TrackCap (MC, a medication event monitoring system), pill count (PC) and plasma HIV viraemia in a publicly funded specialist HIV clinic.
  
  
  METHODS
  Patients self-medicating antiretroviral therapy who were not cognitively impaired and were able to read and understand English.
  
  
  RESULTS
  Mean adherence by MC of the 78 subjects was 92.9% (SE, 1.8%) and by PC 96.8% (SE, 1.4%). Agreement between MC and responses to items about doses missed 1, 2 or 3 days ago was low (kappa = 0.23 (P < 0.03), 0.44 (P < 0.001) and 0.28 (P < 0.01) respectively). This improved when these responses were summated (kappa = 0.46;P < 0.001) and was similar to that for recall of non-adherence over the preceding 2 weeks (kappa = 0.54; P < 0.001). Mean self-reported adherence by visual analogue scale (VAS) over the preceding month was 93.3% (SE, 1.2%). This was strongly associated with both MC (r = 0.63; P < 0.001) and PC (r = 0.75; P < 0.001). On multivariate analysis, the strongest association between a MASRI item and MC was for the VAS. Both the 2 week recall and VAS items were inversely associated with viral load (P = 0.01). There was no association between dose timing (measured MC or questionnaire) or 3 day self-report and viral load.
  
  
  CONCLUSIONS
  The MASRI provides a means of measuring patient adherence that is valid when compared with objective measures.
authors.affiliation: St Stephen's Centre, Chelsea and Westminster Hospital, London, UK.
authors.forename: John C
authors.initials: JC
authors.lastname: Walsh
authors.forename: Sundhiya
authors.initials: S
authors.lastname: Mandalia
authors.forename: Brian G
authors.initials: BG
authors.lastname: Gazzard
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D001330:Electronic Data Processing; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy / Q000523:psychology* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D016014:Linear Models; D008297:Male; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D012646:Self Administration / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D019562:Viral Load; D014766:Viremia
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors