Skip to main content

Advertisement

SpringerLink
Log in

A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine Clinical Care: Is Longer Better?

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

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.

Resumen

Aún hay preguntas pendientes relacionadas con los períodos de tiempo óptimos para preguntar sobre el cumplimiento en la atención clínica. Comparamos períodos de tiempo de 4, 7, 14, 30 y 60 días de dosis omitidas de elementos con niveles de carga viral entre 1099 pacientes sometidos a terapia antirretroviral en la atención de rutina. Llevamos a cabo análisis de regresión logística y lineal para examinar relaciones entre distintos períodos de tiempo y cargas virales con el Promediado Bayesiano de Modelos (BMA, por sus siglas en inglés). Llevamos a cabo análisis de sensibilidad con subgrupos de riesgo incrementado de cumplimiento inferior al óptimo (por ejemplo, pacientes con depresión, consumo de drogas). El período de tiempo de 14 días mostró la diferencia media más importante en los niveles de cumplimiento entre los períodos de tiempo con cargas virales perceptibles e imperceptibles. Los cálculos del BMA sugieren que el período de tiempo de 14 días fue el más predominante entre todos y en la mayoría de los subgrupos, aunque los hallazgos difieren un tanto para los consumidores peligrosos de alcohol y las personas que actualmente presentan depresión. El cumplimiento medido para todos los períodos de tiempo de dosis omitidas se correlacionaron con la carga viral. El cumplimiento calculado de períodos de tiempo intermedios (por ejemplo, 14 días) pareció capturar de mejor forma la conducta de cumplimiento, de acuerdo con lo medido por carga viral.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JS. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4 + cell count is 0.200 to 0.350 × 109 cells/L. Ann Intern Med. 2003;139(10):810–6.

    Article  PubMed  Google Scholar 

  2. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med. 2000;133(1):21–30.

    Article  CAS  PubMed  Google Scholar 

  3. Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14(4):357–66.

    Article  CAS  PubMed  Google Scholar 

  4. Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.

    Article  CAS  PubMed  Google Scholar 

  5. Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JS. Is there a baseline CD4 cell count that precludes a survival response to modern antiretroviral therapy? AIDS. 2003;17(5):711–20.

    Article  PubMed  Google Scholar 

  6. Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375(9731):2092–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Gross R, Bilker WB, Friedman HM, Coyne JC, Strom BL. Provider inaccuracy in assessing adherence and outcomes with newly initiated antiretroviral therapy. AIDS. 2002;16(13):1835–7.

    Article  PubMed  Google Scholar 

  8. Bangsberg DR, Hecht FM, Clague H, et al. Provider assessment of adherence to HIV antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;26(5):435–42.

    Article  CAS  PubMed  Google Scholar 

  9. Bangsberg DR. Monitoring adherence to HIV antiretroviral therapy in routine clinical practice: the past, the present, and the future. AIDS Behav. 2006;10(3):249–51.

    Article  PubMed  Google Scholar 

  10. Osterberg L, Blaschke T. Adherence to medication. N Engl J Med. 2005;353(5):487–97.

    Article  CAS  PubMed  Google Scholar 

  11. Knobel H, Alonso J, Casado JL, et al. Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002;16(4):605–13.

    Article  PubMed  Google Scholar 

  12. Stephenson BJ, Rowe BH, Haynes RB, Macharia WM, Leon G. The rational clinical examination. Is this patient taking the treatment as prescribed? JAMA. 1993;269(21):2779–81.

    Article  CAS  PubMed  Google Scholar 

  13. Kimmerling M, Wagner G, Ghosh-Dastidar B. Factors associated with accurate self-reported adherence to HIV antiretrovirals. Int J STD AIDS. 2003;14(4):281–4.

    Article  PubMed  Google Scholar 

  14. Wagner G. Utility of self-reported antiretroviral adherence: comment on Simoni et al. (2006). AIDS Behav. 2006;10(3):247–8.

    Article  PubMed  Google Scholar 

  15. Simoni JM, Montgomery A, Martin E, New M, Demas PA, Rana S. Adherence to antiretroviral therapy for pediatric HIV infection: a qualitative systematic review with recommendations for research and clinical management. Pediatrics. 2007;119(6):e1371–83.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Liu H, Golin CE, Miller LG, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med. 2001;134(10):968–77.

    Article  CAS  PubMed  Google Scholar 

  17. Arnsten JH, Demas PA, Farzadegan H, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis. 2001;33(8):1417–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Lu M, Safren SA, Skolnik PR, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.

    Article  PubMed  Google Scholar 

  19. Wilson IB, Carter AE, Berg KM. Improving the self-report of HIV antiretroviral medication adherence: is the glass half full or half empty? Curr HIV/AIDS Rep. 2009;6(4):177–86.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Walsh JC, Mandalia S, Gazzard BG. Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome. AIDS. 2002;16(2):269–77.

    Article  PubMed  Google Scholar 

  21. Oyugi JH, Byakika-Tusiime J, Charlebois ED, et al. Multiple validated measures of adherence indicate high levels of adherence to generic HIV antiretroviral therapy in a resource-limited setting. J Acquir Immune Defic Syndr. 2004;36(5):1100–2.

    Article  CAS  PubMed  Google Scholar 

  22. Simoni JM, Kurth AE, Pearson CR, Pantalone DW, Merrill JO, Frick PA. Self-report measures of antiretroviral therapy adherence: a review with recommendations for HIV research and clinical management. AIDS Behav. 2006;10(3):227–45.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Nieuwkerk PT, Oort FJ. Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: a meta-analysis. J Acquir Immune Defic Syndr. 2005;38(4):445–8.

    Article  PubMed  Google Scholar 

  24. Feldman BJ, Fredericksen RJ, Crane PK, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2012;17(1):307–18.

    Article  Google Scholar 

  25. Mannheimer S, Thackeray L, Huppler Hullsiek K, et al. A randomized comparison of two instruments for measuring self-reported antiretroviral adherence. AIDS Care. 2008;20(2):161–9.

    Article  CAS  PubMed  Google Scholar 

  26. Simoni JM, Huh D, Wang Y, et al. The validity of self-reported medication adherence as an outcome in clinical trials of adherence-promotion interventions: findings from the MACH14 study. AIDS Behav. 2014;18(12):2285–90.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Thompson MA, Mugavero MJ, Amico KR, et al. Guidelines for improving entry into and retention in care and antiretroviral adherence for persons with HIV: evidence-based recommendations from an International Association of Physicians in AIDS Care panel. Ann Intern Med. 2012;156(11):817–33.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Stirratt MJ, Dunbar-Jacob J, Crane HM, et al. Self-report measures of medication adherence behavior: recommendations on optimal use. Transl Behav Med. 2015;5(4):470–82.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Amico KR, Zuniga JM, Wilson IB, Gross R, Young B. Provider guidance for linking patients to antiretroviral therapy adherence interventions: recommendations from an IAPAC advisory committee on adherence monitoring and support. J Int Assoc Provid AIDS Care. 2013;12(2):79–83.

    Article  PubMed  Google Scholar 

  30. Pearson CR, Simoni JM, Hoff P, Kurth AE, Martin DP. Assessing antiretroviral adherence via electronic drug monitoring and self-report: an examination of key methodological issues. AIDS Behav. 2007;11(2):161–73.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Fredericksen RJ, Crane PK, Tufano J, et al. Integrating a web-based patient assessment into primary care for HIV-infected adults. J AIDS HIV Res. 2012;4(2):47–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Crane HM, Fredericksen R, Feldman B, et al. The effect of pre-visit reports to providers of patient reported outcomes (PROs) in routine clinical care. Paper presented at: 6th International Conference on HIV Treatment and Prevention Adherence. Miami, FL; 2011.

  33. Crane HM, Lober W, Webster E, et al. Routine collection of patient-reported outcomes in an HIV clinic setting: the first 100 patients. Curr HIV Res. 2007;5(1):109–18.

    Article  CAS  PubMed  Google Scholar 

  34. Crane HM, Grunfeld C, Harrington RD, Uldall KK, Ciechanowski PS, Kitahata MM. Lipoatrophy among HIV-infected patients is associated with higher levels of depression than lipohypertrophy. HIV Med. 2008;9(9):780–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Lawrence ST, Willig JH, Crane HM, et al. Routine, self-administered, touch-screen, computer-based suicidal ideation assessment linked to automated response team notification in an HIV primary care setting. Clin Infect Dis. 2010;50(8):1165–73.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Amico KR, Fisher WA, Cornman DH, et al. Visual analog scale of ART adherence: association with 3-day self-report and adherence barriers. J Acquir Immune Defic Syndr. 2006;42(4):455–9.

    Article  PubMed  Google Scholar 

  37. Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000;12(3):255–66.

    Article  CAS  PubMed  Google Scholar 

  38. Newcombe DA, Humeniuk RE, Ali R. Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site. Drug Alcohol Rev. 2005;24(3):217–26.

    Article  PubMed  Google Scholar 

  39. WHO Assist Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction. 2002;97(9):1183–94.

    Article  Google Scholar 

  40. Tucker JS, Burnam MA, Sherbourne CD, Kung FY, Gifford AL. Substance use and mental health correlates of nonadherence to antiretroviral medications in a sample of patients with human immunodeficiency virus infection. Am J Med. 2003;114(7):573–80.

    Article  PubMed  Google Scholar 

  41. Ingersoll K. The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment. AIDS Care. 2004;16(2):199–211.

    Article  CAS  PubMed  Google Scholar 

  42. Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT): validation in a female veterans affairs patient population. Arch Intern Med. 2003;163(7):821–9.

    Article  PubMed  Google Scholar 

  43. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.

    Article  CAS  PubMed  Google Scholar 

  44. Gual A, Segura L, Contel M, Heather N, Colom J. AUDIT-3 and AUDIT-4: effectiveness of two short forms of the alcohol use disorders identification test. Alcohol Alcoholism. 2002;37(6):591–6.

    Article  PubMed  Google Scholar 

  45. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.

    Article  CAS  PubMed  Google Scholar 

  46. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Raftery A, Madigan D, Hoeting J. Bayesian model averaging for linear regression models. J Am Stat Assoc. 1997;92(437):179–91.

    Article  Google Scholar 

  48. Raftery A. Bayesian model selection in social research. Sociol Methodol. 1995;25:111–63.

    Article  Google Scholar 

  49. Hoeting J, Madigan D, Raftery A, Volinsky C. Bayesian model averaging: a tutorial. Stat Sci. 1999;14(4):382–417.

    Article  Google Scholar 

  50. Volinsky C, Madigan D, Raftery A, Kronmal R. Bayesian model averaging in proportional hazard models: assessing the risk of a stroke. Appl Stat. 1997;46(3):443–8.

    Google Scholar 

  51. Viallefont V, Raftery AE, Richardson S. Variable selection and Bayesian model averaging in case-control studies. Stat Med. 2001;20(21):3215–30.

    Article  CAS  PubMed  Google Scholar 

  52. Nieuwkerk PT, Sprangers MA, Burger DM, et al. Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Arch Intern Med. 2001;161(16):1962–8.

    Article  CAS  PubMed  Google Scholar 

  53. Berg KM, Wilson IB, Li X, Arnsten JH. Comparison of antiretroviral adherence questions. AIDS Behav. 2012;16(2):461–8.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Wilson IB, Fowler FJ Jr, Cosenza CA, et al. Cognitive and field testing of a new set of medication adherence self-report items for HIV care. AIDS Behav. 2013. doi:10.1007/s10461-013-0610-1.

    Google Scholar 

Download references

Acknowledgments

We thank the patients, staff, and providers of the University of Washington (UW) Harborview Medical Center Madison HIV Clinic.

Funding

This work was supported by the National Institutes of Mental Health (NIMH) at the National Institutes of Health [R01 MH084759] and the Office of Behavioral and Social Sciences Research at the National Institutes of Health [U01AR057954-S]. Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health [CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757] and the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health [U24AA020801, U01AA020793 and U01AA020802].

Author information

Authors and Affiliations

  1. Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA

    H. M. Crane, R. M. Nance, R. J. Fredericksen, A. Church, R. D. Harrington, S. Dhanireddy, W. B. Lober, P. K. Crane & M. M. Kitahata

  2. Epidemiology, University of Washington, Seattle, WA, USA

    J. A. C. Delaney

  3. Psychology, University of Washington, Seattle, WA, USA

    J. M. Simoni

  4. Psychology, University of Miami, Miami, FL, USA

    S. A. Safren

  5. Psychiatry, Johns Hopkins University, Baltimore, MA, USA

    M. E. McCaul

  6. Health Services, Policy & Practice, Brown University, Providence, RI, USA

    I. B. Wilson

  7. Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    M. J. Mugavero

Authors
  1. H. M. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. M. Nance
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. A. C. Delaney
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. J. Fredericksen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Church
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. M. Simoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. R. D. Harrington
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. S. Dhanireddy
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. A. Safren
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. M. E. McCaul
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. W. B. Lober
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. P. K. Crane
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. I. B. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. M. J. Mugavero
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. M. M. Kitahata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. M. Crane.

Ethics declarations

Conflict of Interest

There are no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study before they completed the clinical assessment.

Research Involving Human Participants and/or Animals

This article does not contain any studies with animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Crane, H.M., Nance, R.M., Delaney, J.A.C. et al. A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine Clinical Care: Is Longer Better?. AIDS Behav 21, 470–480 (2017). https://doi.org/10.1007/s10461-016-1566-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1566-8

Keywords

Search

Navigation