title: Accuracy of self-report of HIV viral load among people with HIV on antiretroviral treatment.
abstract: The aim of the study was to assess, among people living with HIV, knowledge of their latest HIV viral load (VL) and CD4 count.
  
  
  
  Agreement between self-report and clinic record was assessed among 2771 HIV-diagnosed individuals on antiretroviral treatment (ART) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes Study (2011-2012). A confidential self-completed questionnaire collected information on demographic, socioeconomic, HIV-related and health-related factors. Participants were asked to self-report their latest VL [undetectable (≤ 50 copies/mL), detectable (> 50 copies/mL) or "don't know"] and CD4 count (< 200, 200-350, 351-500 or > 500 cells/μL, or "don't know"). Latest clinic-recorded VL and CD4 count were documented.
  
  
  
  Of 2678 participants on ART, 434 (16.2%) did not accurately report whether their VL was undetectable. Of 2334 participants with clinic-recorded VL ≤ 50 copies/mL, 2061 (88.3%) correctly reported undetectable VL; 49 (2.1%) reported detectable VL; 224 (9.6%) did not know their VL. Of 344 participants with clinic-recorded VL > 50 copies/mL, 183 (53.2%) correctly reported detectable VL; 76 (22.1%) reported undetectable VL; 85 (24.7%) did not know their VL. Of 2137 participants who reported undetectable VL, clinic-recorded VL was ≤ 50 copies/mL for 2061 (96.4%) and <1000 copies/mL for 2122 (99.3%). In analyses adjusted for gender/sexual orientation, ethnicity, age and time since starting ART, factors strongly associated with inaccurate self-report of VL (including "don't know") included socioeconomic disadvantage [prevalence ratio (95% CI) for "not" vs. "always" having enough money for basic needs: 2.4 (1.9, 3.1)], poor English fluency [3.5 (2.4, 5.1) vs. UK born], nondisclosure of HIV status [1.7 (1.3, 2.1)], ART nonadherence [2.1 (1.7, 2.7) for three or more missed doses vs. none in the past 2 weeks] and depressive symptoms (PHQ-9 score ≥ 10) [1.9 (1.6, 2.2)]. Overall, 612 (22.9%) of 2667 participants on ART did not accurately self-report whether or not their CD4 count was ≤ 350 cells/μL.
  
  
  
  There is a high level of accuracy of a self-report of undetectable VL in people on ART in the UK. Overall, accurate knowledge of personal VL level varied according to demographic, socioeconomic, HIV-related and health-related factors. Active identification of people who may benefit from increased levels of support and engagement in care is important.
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Sewell
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Daskalopoulou
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: F
authors.initials: F
authors.lastname: Nakagawa
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: F C
authors.initials: FC
authors.lastname: Lampe
authors.affiliation: Mortimer Market Centre, Central and North West London NHS Foundation Trust, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Edwards
authors.affiliation: Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
authors.forename: N
authors.initials: N
authors.lastname: Perry
authors.affiliation: Pennine Acute Hospitals NHS Trust, Manchester, UK.
authors.forename: E
authors.initials: E
authors.lastname: Wilkins
authors.affiliation: Barts Health NHS Trust, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: O'Connell
authors.affiliation: East Sussex Healthcare NHS Trust, Eastbourne, UK.
authors.forename: M
authors.initials: M
authors.lastname: Jones
authors.affiliation: HIV i-Base, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Collins
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Speakman
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: A N
authors.initials: AN
authors.lastname: Phillips
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
authors.forename: A J
authors.initials: AJ
authors.lastname: Rodger
authors.affiliation: Research Department of Infection & Population Health, University College London, London, UK.
mesh_terms: D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D011795:Surveys and Questionnaires; D006113:United Kingdom; D019562:Viral Load; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: CD4 count; HIV knowledge; HIV viral load; accuracy of self-report; engagement in care; medical record; socioeconomic status