Might ART Adherence Estimates Be Improved by Combining Biomarker and Self-Report Data?

Area of Science:

• Public Health
• Infectious Diseases
• Pharmacology

Background:

• Accurate measurement of antiretroviral therapy (ART) adherence is crucial for understanding viral suppression in people living with HIV (PLHIV).
• Self-reported adherence is prone to bias, while biomarker data, though superior, can be affected by drug-drug interactions and genetic variations.
• This study explores combining both methods for a more precise ART adherence assessment.

Purpose of the Study:

• To investigate the feasibility of integrating biomarker and self-report data for a more accurate measurement of ART adherence.
• To assess ART adherence levels in Manicaland province, Zimbabwe, using a novel combined measurement approach.

Main Methods:

• Utilized data from a 2009-2011 general population survey in Manicaland, Zimbabwe.
• Collected self-report adherence data and analyzed dried blood spot samples for ART medication traces from 560 HIV-infected adults on ART.
• Developed a three-category adherence measure combining biomarker data with self-report adjustments for drug concentration anomalies.

Main Results:

• The combined measure estimated good ART adherence at 69% and excellent adherence at 53%.
• Regression analysis revealed that men and younger participants were more likely to have poor adherence.
• Higher socio-economic status and urban location were associated with better ART adherence.

Conclusions:

• Combining biomarker and self-reported adherence measures can yield more accurate ART adherence data.
• ART adherence in Manicaland is estimated at a maximum of 69%, indicating a significant gap from the UNAIDS 90% viral suppression target.
• Targeted interventions are needed to improve ART adherence, especially among young males in rural eastern Zimbabwe.