A practical method to calibrate self-reported adherence to antiretroviral therapy.
OBJECTIVE
Self-report of antiretroviral medications adherence is inexpensive and simple to use in clinical settings but grossly overestimates adherence. We investigated methods to calibrate patients' self-reported adherence to match objectively measured adherence more closely for the purpose of developing a practical and more accurate self-reported adherence measure.


METHODS
Longitudinal cohort design.


METHODS
Using data from 2 prospective longitudinal clinical investigations conducted at 5 HIV clinics, we examined the discrepancy between self-reported adherence and objectively measured adherence. We evaluated the relation between attitudinal measures and the degree of discrepancy and used a cross-validation approach to propose candidate items to improve adherence survey methodology.


RESULTS
Among 330 patients, self-reported adherence was consistently higher than objectively measured adherence. The best calibration models included the patient's self-reported adherence, duration of the antiretroviral regimen, and attitudinal measures (ability to take medication as instructed, believing medication can help one to live longer, whether or not it is too troublesome to take antiretrovirals, and feeling things are going the right way).


CONCLUSIONS
The method efficiently identified survey items to improve self-reported adherence measurement. The calibrated measure more closely approximates objectively measured adherence and is more sensitive for detecting nonadherence. These models merit evaluation in other settings.
Liu
Honghu
H
Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1736, USA. hhliu@ucla.edu
Miller
Loren G
LG
Hays
Ron D
RD
Wagner
Glenn
G
Golin
Carol E
CE
Hu
Wenhua
W
Kahn
Katherine
K
Haubrich
Richard
R
Kaplan
Andrew H
AH
Wenger
Neil S
NS
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010349:Patient Compliance / Q000706:statistics & numerical data*; D015203:Reproducibility of Results
D019380:Anti-HIV Agents