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A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine
H M Crane1, R M Nance2, J A C Delaney3
1Medicine, University of Washington, Harborview Medical Center, 325 9th Ave, Box 359931, Seattle, WA, 98106, USA. hcrane@uw.edu.
AIDS and Behavior
|October 8, 2016
Summary
The 14-day missed dose timeframe best captures antiretroviral therapy adherence, correlating strongly with viral load. This adherence measure is crucial for effective patient care and treatment outcomes.
Area of Science:
- Clinical Pharmacy
- Public Health
- Infectious Diseases
Background:
- Assessing patient adherence to antiretroviral therapy (ART) is critical for managing HIV/AIDS.
- Optimal timeframes for querying missed doses in clinical settings remain unclear.
- Viral load is a key indicator of ART effectiveness and adherence.
Purpose of the Study:
- To compare the effectiveness of different missed dose timeframes (4-, 7-, 14-, 30-, 60-day) in assessing ART adherence.
- To determine which timeframe best correlates with viral load levels in patients receiving routine care.
Main Methods:
- A cohort of 1099 patients on ART provided data on missed doses over various timeframes.
- Logistic and linear regression analyses, with Bayesian model averaging (BMA), were used to examine associations between adherence timeframes and viral load.
- Sensitivity analyses were performed on subgroups at higher risk for suboptimal adherence.
Main Results:
- The 14-day missed dose timeframe demonstrated the largest mean difference in adherence between patients with detectable and undetectable viral loads.
- BMA estimates indicated the 14-day timeframe was the strongest overall predictor of viral load, with some variations in specific subgroups (e.g., hazardous alcohol users, those with depression).
- All assessed adherence timeframes showed a correlation with viral load, but intermediate timeframes, particularly 14-day, were most effective.
Conclusions:
- The 14-day missed dose timeframe appears to be the most effective for assessing antiretroviral therapy adherence in routine clinical care.
- Utilizing intermediate timeframes for adherence assessment can better capture patient behavior as reflected by viral load.
- These findings can inform clinical practice for more accurate adherence monitoring in HIV management.
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