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Comparing Self-Reports, Pill Counts, and Electronic Devices in Assessing Antiretroviral Therapy Adherence and its
Samuel Kizito1, Fred M Ssewamala1, Josephine Nabayinda2
1McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY.
Background:
We compared the performance of self-reports, pill counts, and electronic adherence measures in monitoring antiretroviral therapy (ART) adherence and association with viral suppression among adolescents living with HIV (ALHIV).
Setting:
This study was conducted among 39 study clinics in the Greater Masaka region in Southern Uganda.
Methods:
We used baseline data from 702 ALHIV aged 10-16 years receiving ART. Self-report was assessed using a three-item tool and pill counts were unannounced, while Wisepill captured device openings over 30 days. We determined the sensitivity, specificity, and area under the receiver-operator characteristic (ROC) curve for each adherence measure in discriminating ALHIV based on their viral suppression (<200 copies/mL) status. We also fit multilevel logistic regression models to determine the association between each adherence measure and viral suppression.
Results:
On average, 73% of ALHIV reported good (≥90%) ART adherence, while 67.1% of ALHIV achieved viral suppression. We found disagreement between adherence measures, with agreement coefficient ranging between 0.410 (self-report vs. Wisepill) and 0.545 for pill counts vs. Wisepill. All 3 adherence measures had low ability to predict viral suppression, with AUCs ranging between 0.560 for pill counts and 0.616 for self-reported adherence. Only self-reported adherence had a significant relationship with viral suppression, with OR = 2.16 (95% CI: 1.25 to 3.81) and P = 0.006.
Conclusions:
Substantial discrepancies exist across adherence measures. In this setting, low self-reported adherence can help in identifying adolescents at risk of virologic failure, although high self-reported adherence does not reliably exclude viremia.
