title: Medication possession ratio associated with short-term virologic response in individuals initiating antiretroviral therapy in Namibia.
abstract: The visual-analogue scale (VAS), Likert item (rating scale), pills identification test (PIT), and medication possession ratio (MPR) provide estimates of antiretroviral therapy (ART) adherence which correlate with HIV viral suppression. These simple adherence measures are inexpensive and easy to administer; however, require validation and adjustment prior to implementation. The objective of this study was to define the optimal adherence assessment measure in Namibia to identify patients at risk for sub-optimal adherence and poor virologic response 6 months after ART initiation. We conducted a cross-sectional survey in HIV-infected adults receiving ART for 6-12 months prior to the adherence assessment. Adherence measures included 30-day VAS, 30-day Likert item, self-reported treatment interruptions, PIT, and MPR. Association of adherence measures with 6-month HIV-1 RNA level was assessed using two thresholds (1000 copies/mL and 5000 copies/mL). Adherence was assessed in 236 patients, mean age 37.3 years, 54% female. Mean adherence was 98.1% by 30-day VAS, 84.7% by 30-day Likert item, 97.0% by self-reported treatment interruptions, 90.6% by PIT, and 98.8% by MPR. Agreement between adherence measures was poor using kappa statistic. 76% had HIV-1 RNA <1000 copies/ml, and 88% had HIV-1 RNA <5000 copies/ml. MPR (continuous) was associated with viral suppression <5000 copies/ml (p = 0.036). MPR <75% was associated with virologic failure at ≥5000 copies/ml with OR 3.89 (1.24, 12.21), p = 0.013. Adherence was high with all measures. Only MPR, was associated with short-term virologic response, suggesting its cross-culturally utility for early identification of patients at high risk for virologic failure.
authors.affiliation: Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, United States of America.
authors.forename: Steven Y
authors.initials: SY
authors.lastname: Hong
authors.forename: Logan
authors.initials: L
authors.lastname: Jerger
authors.forename: Anna
authors.initials: A
authors.lastname: Jonas
authors.forename: Alfons
authors.initials: A
authors.lastname: Badi
authors.forename: Steven
authors.initials: S
authors.lastname: Cohen
authors.forename: Jean B
authors.initials: JB
authors.lastname: Nachega
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Parienti
authors.forename: Alice M
authors.initials: AM
authors.lastname: Tang
authors.forename: Christine
authors.initials: C
authors.lastname: Wanke
authors.forename: Norma
authors.initials: N
authors.lastname: Terrin
authors.forename: Dawn
authors.initials: D
authors.lastname: Pereko
authors.forename: Abraham
authors.initials: A
authors.lastname: Blom
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Trotter
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jordan
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008297:Male; D009276:Namibia / Q000453:epidemiology; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012367:RNA, Viral / Q000032:analysis
chemical_list: D012367:RNA, Viral