CASE
STUDY ABSTRACT, OBJECTIVES & DESIGN
CASE
The Center for Adherence Support Evaluation
at the New York Academy of Medicine
A Multi-Method Approach to Measuring Antiretroviral Therapy (ART) Adherence from the Cross-Site New York Academy of Medicine Center for Adherence Support Evaluation /HRSA SPNS Adherence Collaboration
Background: High rates of adherence to ART is critical to success with treatment. However, the optimal measure of adherence in clinical practice is still unknown.
Methods: As part of the New York Academy of Medicine/ HRSA initiative, we are evaluating the impact of 13 adherence support programs. Adherence was measured using 3-day self-report, last time missed and number of days/week with a missed dose. Baseline adherence data from the 312 patients from 8 of the 13 sites on ART at enrollment were used in these analyses to evaluate the relationship among different adherence measures. Data were collected through face-to-face interviews using a standardized adherence questionnaire.
Results: The sample was 39% female, 68% minority; 47% reported mental illness and 16% active drug use. Only 29% had a viral load <400 at baseline.
Nonadherence (>1 dose missed) by 3-day recall correlated with frequency
of days/week with a missed dose (p=.001), difficulty taking medications
on time (p=.001), and last time missed dose (p=.001). Presence and number
of side effects predicted adherence (p=.001).
No correlation was seen between nonadherence on 3-day recall and the following
baseline measures: difficulty following special instructions, health status,
number, class or specific ART, or baseline viral load and CD4 count.
| Measure |
Missed>1 dose on baseline
3 day recall
|
No missed dose on 3 day recall
|
P value
|
| Days/week with missed dose=0/<1 per week |
28%
|
81%
|
.001
|
| Last time missed=never/>1mo |
3%
|
66%
|
.001
|
| Difficulty taking on time=never/rarely |
58%
|
88%
|
.001
|
| ARV-related side effect |
61%
|
28%
|
.001
|
| "A lot" of difficulty taking ART due to side effects |
23%
|
3%
|
.001
|
Conclusions: Correlations between a number
of self-report adherence measures were found in this diverse multi-site
population. As more data are collected, we will be able to develop a composite
adherence measure to improve accuracy of adherence assessment in the field.
CASE
The New York Academy of Medicine
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New York, NY 10029
(212) 822-7237
Last updated: 4/11/02