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Brief report: assessing adherence to pediatric antiretroviral regimens using the 24-hour recall interview
Stephanie L Marhefka1, Vicki J Tepper, John J Farley
1HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, New York 10032, USA. sm2443@columbia.edu
Insights
The 24-hr Recall Interview (24RI) shows moderate reliability for assessing children's antiretroviral adherence. While promising for reducing social desirability bias, its validity needs improvement for clinical use in HIV care.
Area of Science:
- Pediatric infectious diseases
- Pharmacological adherence research
- HIV/AIDS treatment monitoring
Background:
- Assessing antiretroviral medication adherence in children with HIV is crucial for treatment efficacy.
- Traditional self-report methods may be influenced by social desirability bias.
- The 24-hr Recall Interview (24RI) offers a structured approach to recall medication-taking behavior.
Purpose of the Study:
- To evaluate the reliability and validity of the 24-hr Recall Interview (24RI) for assessing antiretroviral adherence in children.
- To explore the relationship between 24RI-derived adherence metrics and objective measures like viral load and pharmacy refill rates.
- To determine if reporting adherence barriers via 24RI correlates with treatment outcomes.
Main Methods:
- A telephone-based study involving caregivers of 54 children (aged 2-12 years) with HIV.
- Participants completed both a clinical adherence interview and the 24RI.
- Objective data included children's viral load and 3-month pharmacy refill records.
Main Results:
- Thirty-seven percent of children missed at least one antiretroviral dose over a 3-day period.
- Adherence varied across different medications in 22% of cases.
- 24RI adherence scores demonstrated moderate reliability; pharmacy refill rates correlated significantly with viral load.
Conclusions:
- The 24RI may mitigate social desirability bias due to its systematic recall and reduced emphasis on adherence.
- Identifying adherence barriers through 24RI may signal potential difficulties in medication management.
- Further improvements in the 24RI's validity are necessary for its integration into comprehensive adherence assessment batteries.
Objective:
Examine the 24-hr Recall Interview (24RI) for assessing children's antiretroviral medication adherence.
Methods:
Caregivers of 54 children with HIV (aged 2-12 years) completed a clinical adherence interview and the 24RI by telephone. Children's viral load and 3-month pharmacy records were obtained.
Results:
Thirty-seven percent of children missed > or = 1 dose of medicine over 3 days. In 22% of the samples, adherence varied across medications. The 24RI adherence scores (Frequency, Interval, and Dietary Adherence) were moderately reliable across the three interviews. Pharmacy refill rates were significantly related to viral load, and 24RI barriers were marginally significantly related to viral load.
Conclusions:
The 24RI, with its systematic, cued recall, and decreased focus on adherence, may reduce socially desirable responding compared to other self-report methods, and reporting adherence barriers may indicate adherence difficulty. However, the validity of the 24RI must be improved to make it a useful measure to include in an adherence assessment battery.
