Ascertaining baseline levels of antiretroviral therapy adherence in Uganda: a multimethod approach.
BACKGROUND
Many antiretroviral treatment (ART) adherence measurement methods have been employed by different studies, but no single method has been found to be appropriate for all settings. This study aimed to determine baseline levels of adherence using 2 measures of adherence.


METHODS
Levels of adherence in 967 patients continuing to receive ART in 4 health facilities were assessed over a 28-week period using a clinic-based pill count method and a patient self-report questionnaire. Factors associated with adherence were also determined.


RESULTS
Mean adherence (95% confidence interval) was 97.3% (96.8% to 97.9%) and 98.4% (97.9% to 98.8%) for the clinic-based pill count and patient self-report methods, respectively. Proportion of clients achieving optimal adherence (≥ 95%) was 89.9% by pill count and 94.2% by self-report. The 2 adherence measures were closely correlated with each other (r = 0.87, P = 0.000). Adherence increased with age (P = 0.014) with patients aged 40 years and below being less likely to achieve optimal adherence [odds ratio = 0.55; 95% confidence interval (0.34 to 0.89)].


CONCLUSIONS
There is a very high level of optimal adherence among patients still on treatment. The combined use of these 2 replicable and reliable methods of measuring adherence is vital to ART programs in resource-constrained settings.
Nuffield Centre for International Health and Development, Institute of Health Sciences, Leeds University, Leeds, UK. skk31@cantab.net
Setor
S
Kunutsor
Morgan
M
Evans
Janine
J
Thoulass
John
J
Walley
Elly
E
Katabira
James N
JN
Newell
Simon
S
Muchuro
Hudson
H
Balidawa
Elizabeth
E
Namagala
Eric
E
Ikoona
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016001:Confidence Intervals; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult; D016903:Drug Monitoring
D019380:Anti-HIV Agents