title: The Scale of Self-Efficacy Expectations of Adherence to Antiretroviral Treatment: A Tool for Identifying Risk for Non-Adherence to Treatment for HIV.
abstract: BACKGROUND
  Identification of risk for non-adherence to treatment is a challenge for personalized care for people living with HIV. Standardized questionnaires of patients' expectations of their capability to overcome obstacles for treatment adherence may be used as a pre-screening for risk identification. A scale of self-efficacy expectations of adherence to antiretroviral treatment (SEA-ART scale) was previously developed. This study assesses the scale validity in predicting non-adherence to ART in adults living with HIV.
  
  
  RESULTS
  A prospective cohort study applied a 21-item SEA-ART scale to 275 adults in ART treatment at an outpatient public service for HIV in Southern Brazil. ART medications taken were assessed at one-month follow-up; ART adherence was devised as an intake of 95% and more of the prescribed medication. A SEA-ART score was calculated by adding up the scores of all items. Multivariable logistic regression and the Area Under the Receiver-Operating-Characteristic Curve (AUROC) were applied to examine the ability of the SEA-ART score to predict non-adherence at follow-up. The SEA-ART score varied from 21 to 105; mean 93.9; median 103.0. Non-adherence was 30.3% (n = 81/267). The odds of non-adherence was 8% lower for each unit increase of the SEA-ART score; after adjustment for age, sex, formal education and time in treatment (OR = 0.92; 95%CI 0.90-0.95; LRT for linear trend, p = 0.002). The AUROC was 0.80 (95%CI 0.73-0.87; p<0.001). The SEA-ART optimal cut-off value was 101, providing a sensitivity of 76.5%, a specificity of 73.1%, a positive predictive value of 55.4% and a negative predictive value of 87.7%. There was no evidence of difference in sensitivity, and specificity among groups organized by age, gender, formal education and time in treatment.
  
  
  CONCLUSIONS
  The SEA-ART scale appears to have a good capacity to discriminate between adherents and non-adherents at one-month follow-up. Further studies should confirm these results in other populations.
authors.affiliation: Secretaria da Saúde do Estado do Rio Grande do Sul, Governo do Estado do Rio Grande do Sul, Av. Bento Gonçalves 3722, CEP: 90650-001, Porto Alegre, RS, Brazil.
authors.forename: Maria de Lourdes
authors.initials: Mde L
authors.lastname: Drachler
authors.affiliation: Rede Governo Colaborativo em Saúde, Universidade Federal do Rio Grande do Sul, Av. João Pessoa 155, CEP: 90040-001, Porto Alegre, RS, Brazil.
authors.forename: Carlos Wietzke
authors.initials: CW
authors.lastname: Drachler
authors.affiliation: Programa de Pós-Graduação em Saúde Coletiva, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Rua São Manoel 963, CEP: 90.620-110, Porto Alegre, RS, Brazil.
authors.forename: Luciana Barcellos
authors.initials: LB
authors.lastname: Teixeira
authors.affiliation: Mestrado Profissional em Saúde e Desenvolvimento Humano, Centro Universitário La Salle, Av. Victor Barreto, 2288, CEP: 92010-000, Canoas, RS, Brazil.
authors.forename: José Carlos de Carvalho
authors.initials: JC
authors.lastname: Leite
mesh_terms: D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001938:Brazil / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D020377:Self Efficacy; D057566:Self Report; D055815:Young Adult