Patient-reported and physician-estimated adherence to HAART: social and clinic center-related factors are associated with discordance.
OBJECTIVE
To evaluate the rate of discordance between patients and physicians on adherence to highly active antiretroviral therapy (HAART) and identify factors related to discordance in these two assessments.


METHODS
Prospective, multicenter, cohort study (AdICONA) nested within the Italian Cohort Naive Antiretrovirals (ICONA) study.


METHODS
Tertiary clinical centers.


METHODS
The patients filled out a 16-item self-administered questionnaire on adherence to HAART. At the same time, physicians estimated the current HAART adherence of their patient.


METHODS
Discordance between patient and physician on adherence to antiretroviral therapy.


RESULTS
From May 1999 to March 2000, 320 paired patient-physician assessments were obtained. Patients had a mean plasma HIV RNA of 315 copies/ml (64% had undetectable HIV RNA) and a mean CD4+ cell count of 577 cells x 10(6)/L. Nonadherence was reported by 30.9% of patients and estimated by physicians in 45.0% cases. In 111 cases (34.7%), patients and physicians were discordant on adherence to HAART. Kappa statistics was 0.27. Using patient-assessed adherence as reference, sensitivity, specificity, positive predictive value, and negative predictive value of physician-estimated adherence were 64.7%, 66.6%, 81.2%, and 45.8%, respectively. On multivariable analysis, low education level, unemployment, absence of a social worker in the clinical center, and unavailability of afternoon visits were significantly correlated with patient-physician discordance on adherence to antiretrovirals.


CONCLUSIONS
Physicians did not correctly estimate patient-reported adherence to HAART in more than one third of patients. Both social variables and factors related to the clinical center were important predictors of discordance between patients and physicians. Interventions to enhance adherence should include strategies addressed to improve patient-physician relationship.
Murri
Rita
R
Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, 00168 Rome, Italy. ritamurri@libero.it
Ammassari
Adriana
A
Trotta
Maria Paola
MP
De Luca
Andrea
A
Melzi
Sara
S
Minardi
Cristina
C
Zaccarelli
Mauro
M
Rellecati
Patrizia
P
Santopadre
Paola
P
Soscia
Fabrizio
F
Scasso
Antonio
A
Tozzi
Valerio
V
Ciardi
Maria
M
Orofino
Gian Carlo
GC
Noto
Pasquale
P
Monforte
Antonella d'Arminio
Ad
Antinori
Andrea
A
Wu
Albert W
AW
D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D004522:Educational Status; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors