Approaches to identifying appropriate medication adherence assessments for HIV infected individuals with comorbid bipolar disorder.
Assessing medication adherence in already difficult-to-treat HIV-infected subpopulations presents a unique challenge. The objective of this study was to compare different approaches to assessing medication adherence: (1) electronic medication monitoring, (2) standardized self-report questionnaire, and (3) self-report visual analogue scale, and to determine whether antiretroviral therapy (ART) adherence measures differed for HIV-infected persons with bipolar disorder (HIV+ /BD+) as compared to HIV-infected persons without bipolar disorder (HIV+ /BD-). ART adherence was assessed for 74 HIV-positive participants using the Medication Event Monitoring System (MEMS), AIDS Clinical Trials Group (ACTG) adherence questionnaire, and visual analogue scale (VAS). Participants were classified as adherent or nonadherent on each measure by previously validated cutscores. Correlations and logistic regressions were used to examine associations between adherence measures and demographic and clinical variables. In the HIV+ /BD- group, significant correlations existed between each self-report measure and the MEMS. Males comprised 81% of the study population. Participants averaged 44 years of age and 13 years of education. No significant correlations were found among adherence measures in the HIV+ /BD+ group. Among participants reporting adherence on either self-report measure but classified as nonadherent based on MEMS, 94% had a diagnosis of bipolar disorder. Bipolar disorder was a significant predictor of adherence classification discordance among self-report measures. Our findings suggest that it remains difficult to assess ART adherence among HIV-positive individuals with bipolar disorder. Combined approaches of self-report and objective measures may be the best way to estimate adherence, and may provide the best basis for interventions designed to improve adherence in difficult-to-treat populations.
Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California, USA.
Jayraan
J
Badiee
Patricia K
PK
Riggs
Alexandra S
AS
Rooney
Florin
F
Vaida
Igor
I
Grant
J Hampton
JH
Atkinson
David J
DJ
Moore
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D002140:California / Q000453:epidemiology; D015897:Comorbidity; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D010147:Pain Measurement; D012307:Risk Factors; D057566:Self Report; D016903:Drug Monitoring
D019380:Anti-HIV Agents; D014150:Antipsychotic Agents