title: A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine Clinical Care: Is Longer Better?
abstract: Questions remain regarding optimal timeframes for asking about adherence in clinical care. We compared 4-, 7-, 14-, 30-, and 60-day timeframe missed dose items with viral load levels among 1099 patients on antiretroviral therapy in routine care. We conducted logistic and linear regression analyses examining associations between different timeframes and viral load using Bayesian model averaging (BMA). We conducted sensitivity analyses with subgroups at increased risk for suboptimal adherence (e.g. patients with depression, substance use). The 14-day timeframe had the largest mean difference in adherence levels among those with detectable and undetectable viral loads. BMA estimates suggested the 14-day timeframe was strongest overall and for most subgroups although findings differed somewhat for hazardous alcohol users and those with current depression. Adherence measured by all missed dose timeframes correlated with viral load. Adherence calculated from intermediate timeframes (e.g. 14-day) appeared best able to capture adherence behavior as measured by viral load.
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA. hcrane@uw.edu.
authors.forename: H M
authors.identifier: http://orcid.org/0000-0002-3308-7005
authors.initials: HM
authors.lastname: Crane
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: R M
authors.initials: RM
authors.lastname: Nance
authors.affiliation: Epidemiology, University of Washington, Seattle, WA, USA.
authors.forename: J A C
authors.initials: JA
authors.lastname: Delaney
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: R J
authors.initials: RJ
authors.lastname: Fredericksen
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: A
authors.initials: A
authors.lastname: Church
authors.affiliation: Psychology, University of Washington, Seattle, WA, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Simoni
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: R D
authors.initials: RD
authors.lastname: Harrington
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: S
authors.initials: S
authors.lastname: Dhanireddy
authors.affiliation: Psychology, University of Miami, Miami, FL, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: Safren
authors.affiliation: Psychiatry, Johns Hopkins University, Baltimore, MA, USA.
authors.forename: M E
authors.initials: ME
authors.lastname: McCaul
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: W B
authors.initials: WB
authors.lastname: Lober
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: P K
authors.initials: PK
authors.lastname: Crane
authors.affiliation: Health Services, Policy & Practice, Brown University, Providence, RI, USA.
authors.forename: I B
authors.initials: IB
authors.lastname: Wilson
authors.affiliation: Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Mugavero
authors.affiliation: Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA.
authors.forename: M M
authors.initials: MM
authors.lastname: Kitahata
mesh_terms: D000328:Adult; D019973:Alcohol-Related Disorders / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D001499:Bayes Theorem; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D000073222:Patient Health Questionnaire; D019966:Substance-Related Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents
keywords: Adherence; Depression; Hazardous alcohol use; Substance use; Viral load