title: Assessing adherence in Thai patients taking combination antiretroviral therapy.
abstract: In settings where medications and viral load (VL) monitoring are limited by cost, clinicians need reliable ways to assess patient adherence to therapy. We assessed sensitivity and specificity of two self-reported adherence tools (a visual analogue scale [VAS] and the CASE [Center for Adherence Support Evaluation] adherence index), against a standard of detectable VL, with 288 patients from three sites in Thailand. We also assessed predictors of non-adherence. The sensitivity and specificity of the VAS <95% and CASE adherence index ≤11 against a VL >50 copies/mL were 26% and 90%, 19% and 95%, respectively. Against a VL ≥1000 copies/mL sensitivities increased to 55% and 36%, respectively, and specificities were unchanged. Attending a clinic not staffed by HIV specialists (odds ratio [OR] 3.14; 95% confidence interval [CI] 1.19-8.34) and being educated to primary school level or less (OR 2.24; 95% CI 1.01-4.94) were associated with self-reported adherence <95% on the VAS in multivariate analysis. Adherence assessed by the VAS was a more accurate predictor of detectable VL. Policy-makers in resource-limited settings should ensure that treatment centres are staffed with well-trained personnel aware of the importance of good patient adherence.
authors.affiliation: HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand. stephen.k@hivnat.org
authors.forename: S J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: A
authors.initials: A
authors.lastname: Avihingsanon
authors.forename: O
authors.initials: O
authors.lastname: Putcharoen
authors.forename: P
authors.initials: P
authors.lastname: Chetchotisakd
authors.forename: M
authors.initials: M
authors.lastname: Layton
authors.forename: S
authors.initials: S
authors.lastname: Ubolyam
authors.forename: K
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: D A
authors.initials: DA
authors.lastname: Cooper
authors.forename: P
authors.initials: P
authors.lastname: Phanuphak
authors.forename: C
authors.initials: C
authors.lastname: Duncombe
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D003906:Developing Countries; D059026:Diagnostic Self Evaluation; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D013785:Thailand
chemical_list: D019380:Anti-HIV Agents