title: Physician estimate of antiretroviral adherence in India: poor correlation with patient self-report and viral load.
abstract: Adherence to antiretroviral therapy (ART) is critical in maintaining viral suppression and minimizing resistance in HIV-infected patients. We compared physician estimates of their patients' ART adherence with participant's self-reported adherence to determine patient-provider agreement and identify correlates of discordance in three private clinics in Mumbai, India. Between December 2004 and April 2005, 277 persons receiving ART at three private clinics in Mumbai, India, were interviewed regarding adherence to ART using the Adult AIDS Clinical Trials Group questionnaire. Physicians were also asked to assess their patients' adherence. Quantitative HIV-1 RNA level was determined for 200 participants. Agreement between provider estimate of adherence and participant self-report was low, kappa = 0.058 (95% confidence interval [CI] 0.011-0126). Of 200 participants whose viral load was obtained, viral suppression was associated with participant self-reported adherence (odds ratio [OR] 3.08; 95% CI 1.65-5.74; p < 0.05), but not with provider estimated adherence (OR 1.2; 95% CI 0.67-2.14; p = 0.54). Cost of ART was positively associated with physician underestimation of participant adherence and older age was negatively associated. No independent correlates of physician overestimation of participant adherence were found. There was poor agreement between physician estimate of adherence and patient self-report. Providers should avoid using their own assessment of patient ART adherence. Instead, providers should rely on effective and validated measures, especially when viral load or drug level monitoring are not readily available.
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA. lwalshe@jhsph.edu
authors.forename: Louise
authors.initials: L
authors.lastname: Walshe
authors.forename: D G
authors.initials: DG
authors.lastname: Saple
authors.forename: S H
authors.initials: SH
authors.lastname: Mehta
authors.forename: B
authors.initials: B
authors.lastname: Shah
authors.forename: R C
authors.initials: RC
authors.lastname: Bollinger
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000502:physiology; D006801:Humans; D007194:India; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D010817:Physician-Patient Relations; D012367:RNA, Viral / Q000097:blood; D011795:Surveys and Questionnaires; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral