Journal
JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
Volume 43, Issue -, Pages S104-S112Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/01.qai.0000245888.97003.a3
Keywords
calibration model; cross-validation; predicted residual sum of squares; self-reported adherence
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Funding
- NIAID NIH HHS [AI055320, R01 AI055320] Funding Source: Medline
- NIA NIH HHS [AG-02-004] Funding Source: Medline
- NIMHD NIH HHS [P20MD000184] Funding Source: Medline
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Objective: Self-report of antiretroviral medications adherence is inexpensive and simple to use in clinical settings but grossly overestimates adherence. We investigated methods to calibrate patients' self-reported adherence to match objectively measured adherence more closely for the purpose of developing a practical and more accurate self-reported adherence measure. Design: Longitudinal cohort design. Methods: Using data from 2 prospective longitudinal clinical investigations conducted at 5 HIV clinics, we examined the discrepancy between self-reported adherence and objectively measured adherence. We evaluated the relation between attitudinal measures and the degree of discrepancy and used a cross-validation approach to propose candidate items to improve adherence survey methodology. Results: Among 330 patients, self-reported adherence was consistently higher than objectively measured adherence. The best calibration models included the patient's self-reported adherence, duration of the antiretroviral regimen, and attitudinal measures (ability to take medication as instructed, believing medication can help one to live longer, whether or not it is too troublesome to take antiretrovirals, and feeling things are going the right way). Conclusion: The method efficiently identified survey items to improve self-reported adherence measurement. The calibrated measure more closely approximates objectively measured adherence and is more sensitive for detecting nonadherence. These models merit evaluation in other settings.
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