Reliability and validity of a single-item rating scale to monitor medication adherence for people living with HIV and lower health literacy

Background:

Monitoring medication adherence in clinical and research settings may be especially challenging for people with lower literacy skills.

Objective:

The current study examined the measurement properties of a single-item rating scale (SIRS) for assessing medication adherence in a sample of 468 people living with HIV and lower health literacy skills.

Methods:

Participants completed two versions (computerized and telephone interview) of an SIRS as well as unannounced monthly pill counts. We also collected measures of common correlates of adherence and obtained participants' HIV RNA viral load from medical records.

Results:

Results indicated that the SIRS is time stable over one month (r?=?0.46 to 0.52). There was limited evidence for modality effects between the computerized and phone administered SIRS. Associations with unannounced pill counts demonstrated concurrent and predictive validity of the SIRS, and criterion-related validity by associations with viral load. However, the SIRS also demonstrated inflated adherence estimates relative to unannounced pill counts and these discrepancies were greatest for persons of lower income and who reported alcohol use.

Conclusions:

A simple SIRS to monitor medication adherence may therefore be reliable and valid for use with people challenged by lower literacy skills in both clinical and research settings.     

Information and communication technologies for adherence to antiretroviral treatment in adults with HIV/AIDS

IntroductionInformation and communication technologies support interventions directed at the prevention of HIV transmission and patient monitoring by promoting improved accessibility and quality of care.ObjectiveTo evaluate the efficacy of information and communication technologies in the adherence to antiretroviral treatment in adults with HIV/AIDS.MethodologySystematic review conducted from March to May of 2015 in three databases—the Cumulative Index to Nursing and Allied Health Literature (CINAHL); the Latin-American and Caribbean Literature in Health Sciences (LILACS/BIREME) and SCOPUS; and the Cochrane library and the Medical Literature Analysis and Retrieval System Online portal (MEDLINE/PubMed). The sample consisted of nine randomized clinical trials based on the use of information and communication technologies for adherence to antiretroviral treatment in adults with HIV/AIDS.ResultsThree studies analysed the use of a short message service – SMS – two phone calls, two alarm devices, one web-enabled Hand-held device and one web electronic intervention. Improvements in the levels of adherence in the group subjected to the intervention were identified in seven studies. The phone was the type of information and communication technology with proven efficacy with respect to adherence. It was used to make calls, as well as to send alert messages and reminders about taking medications. Pagers were not considered to be effective regarding adherence to antiretroviral therapy.ConclusionThe integrated use of information and communication technologies with standard care promotes increased access to care, strengthening the relationship between patients and health services, with the possibility of mitigating the difficulties experienced by people with HIV in achieving optimal levels of adherence to drug therapy.     

Literacy, self-efficacy, and HIV medication adherence

OBJECTIVE: We examined the relationship between patient literacy level and self-reported HIV medication adherence, while estimating the mediating roles of treatment knowledge and self-efficacy on this relationship. METHODS: Structured patient interviews with a literacy assessment, supplemented by medical chart review, were conducted among 204 consecutive patients receiving care at infectious disease clinics in Shreveport, Louisiana and Chicago, Illinois. Literacy was measured using the Rapid Estimate of Adult Literacy in Medicine (REALM), while the Patient Medication Adherence Questionnaire (PMAQ) was used to assess medication self-efficacy and adherence to antiretroviral regimens in the past 4 days. RESULTS: Approximately one-third of patients (30.4%) were less than 100% adherent to their regimen, and 31.4% had marginal to low literacy skills. In multivariate analyses, low literate patients were 3.3 times more likely to be non-adherent to their antiretroviral regimen (p < 0.001). Patients' self-efficacy, but not knowledge, mediated the impact of low literacy on medication adherence (AOR 7.4, 95% CI 2.7-12.5). CONCLUSION: While low literacy was a significant risk factor for improper adherence to HIV medication regimens in our study, self-efficacy mediated this relationship. PRACTICE IMPLICATIONS: Comprehensive intervention strategies that go beyond knowledge transfer may be needed to address self-efficacy among patients across all literacy levels to be successful in the management of difficult medication schedules.     

Predictors of Retention in HIV Care Among a National Cohort of US Veterans

Abstract

Background: Poor retention in HIV care leads to poor survival. The predictors of poor retention in HIV care are not well understood, especially from US nationwide datasets. We determined the predictors of poor retention in HIV care among a group of US veterans and examined whether poor retention was confounded by other predictors of survival. Methods: We conducted a retrospective cohort study of 2,619 male US veterans who started antiretroviral therapy after January 1, 1998. Poor retention in HIV care was defi ned as having had at least 1 quarter-year without any primary care visit in the year after starting antiretroviral therapy. Survival was assessed through 2002. Logistic regression and Cox models were constructed. Results: Thirty-six percent of patients had poor retention in care. In multivariable analysis, younger age, Black race/ethnicity, CD4 cell count >350 ×10⁶/L, hepatitis C infection, and illicit drug use were predictive of poor retention in care. Having a chronic medical comorbidity and being identifi ed as a man having sex with men (MSM) were associated with improved retention in care. In multivariable survival analyses, poor retention in care was not a confounder or moderator for other variables that predicted survival. Conclusions: Retention in HIV care is an independent predictor of survival. As routine HIV screening increases, more people with the characteristics predictive of poor retention in care will be identifi ed. Interventions to improve retention in care are needed.     

Content analysis of antiretroviral adherence enhancing interview reports

Objective

To identify factors associated with low or high antiretroviral (ARV) adherence through computational text analysis of an adherence enhancing programme interview reports.

Engagement and Affective Communication During Pediatric Nephrology Clinic Visits: Associations with Medication Adherence

ObjectiveTo evaluate whether engagement and affective communication among adolescents and young adults (AYAs) with chronic kidney disease (CKD), caregivers, and pediatric nephrology providers during outpatient clinic visits predicts antihypertensive medication adherence.MethodsAYAs (n = 60, M age = 15.4 years, SD = 2.7, 40% female, 43% African American/Black) and caregivers (n = 60, 73% female) attended audio-recorded clinic visits with pediatric nephrologists (n = 12, 75% female). Recordings were analyzed using global affect ratings of the Roter Interactional Analysis System. Antihypertensive medication adherence was monitored electronically before and after clinic visits. A linear regression model evaluated associations between affect ratings and post-visit adherence.ResultsAYAs took 84% of doses (SD = 20%) pre-visit and 82% of doses (SD = 24%) post-visit. Higher AYA engagement (β = 0.03, p = .01) and the absence of provider negative affect (β=-0.15, p = .04) were associated with higher post-visit adherence, controlling for pre-visit adherence, AYA sex, age, and race, and clustered by provider.ConclusionsPost-visit adherence was higher when AYAs were rated as more engaged and providers as less negative.Practice ImplicationsAYAs with lower engagement may benefit from further adherence assessment. Communication strategies designed to more actively engage AYAs in their care and diminish provider conveyance of negative affect during clinic visits may positively influence adherence among AYAs with CKD.     

The reliability of reports of medical adherence from children with HIV and their adult caregivers

OBJECTIVE: To compare children's reports of their medication adherence to those of their adult caregivers. METHOD: Several indicators of medication adherence were assessed for 48 adult-child dyads. Kappa statistics were calculated as measures of agreement. RESULTS: Adherence problems were common, although the level of agreement between the child and the adult was quite low (kappas for adherence variables ranged from .05 to .32). Compared to adult-child dyads that agreed, dyads that disagreed tended to include older children who had more responsibility for managing their own medications. CONCLUSIONS: Both researchers and clinicians would benefit from acquiring information on children's adherence from multiple sources.     

Empowering Malian women living with HIV regarding serostatus disclosure management: Short-term effects of a community-based intervention

Objective

The objective of this study was to assess the short-term effects of Gundo-So—a program aimed at empowering Malian women living with HIV (WLHIV) regarding serostatus disclosure management.

The association of benefit finding to psychosocial and health behavior adaptation among HIV+ men and women

Psychological and behavioral adaptation to HIV is integral to long-term survival. Although most research on coping with HIV has focused on factors associated with poor adaptation, recent research has expanded to include positive concomitants of adaptation, such as benefit finding. This study examined the occurrence of benefit finding among HIV+ men and women and evaluated the potential relevance of benefit finding to positive health behavior and psychosocial adaptation. HIV+ participants (N = 221) recruited during outpatient care completed self-report assessments of benefit finding, social support, depression, HAART adherence, substance use, and physical activity. In a series of multivariate analyses that controlled for demographic and health status variables, benefit finding was associated with lower depression scores, greater social support, and more physical activity, but showed no association to HAART adherence or substance use. The association of benefit finding to depression was partially mediated by differences in social support. Thus, benefit finding may improve psychological adjustment by motivating patients who experience stress-related growth to seek social support.     

Effects of incentivizing viral suppression in previously incarcerated adults living with HIV

Background: The amount of HIV in a person’s blood can be suppressed to an undetectable level through antiretroviral therapy medications (ART). Adhering to an ART regimen can improve a person’s health and reduce HIV transmission. Despite these benefits, many people with HIV do not maintain the level of adherence required to achieve an undetectable viral load. This problem is particularly common among people who have been incarcerated.

Objective: To determine effects of incentivizing viral suppression in previously incarcerated adults with HIV.

Methods: Adults with HIV (N?=?102) and detectable viral load (>200 copies/mL) were randomly assigned to a Usual Care or Incentive group. Usual Care participants did not earn incentives for viral suppression. Incentive participants earned incentives ($10/day maximum) for providing blood samples with a reduced or undetectable (<200 copies/mL) viral load. Assessments were conducted every 3 months. Results collected during the first year were aggregated and compared based on group assignment and incarceration history.

Results: Previously incarcerated participants in the Incentive group provided more (OR: 2.9; CI: 1.3-6.8; p <.05) blood samples with an undetectable viral load (69%) than those in the Usual Care group (41%). Never-incarcerated participants in the Incentive group provided more (OR: 6.8; CI: 2.2-21.0; p <.01) blood samples with an undetectable viral load (78%) than those in the Usual Care group (36%). Effects of incentives did not differ by incarceration history.

Conclusions: Incentivizing viral suppression can increase viral suppression (undetectable viral load) in people who have been incarcerated.     

Disengagement and reengagement of HIV continuum of care in a single center cohort in northern Italy

Background: Despite the progress in HIV care, adherence to follow up remains critical. Disengagement impairs the benefit of HIV care and the increasing number of data that associates failed retention with worse outcomes has led public health institutions to consider retention in care as a new tool to fight against HIV pandemic.

Objective: The aim of this retrospective, observational study was to estimate the burden of disengagement and reengagement in care in our HIV cohort and to identify the characteristics of our LTFU and reengaged patients. Moreover, we build our cascade of care to explore how closely our center aligned with the “90–90–90” targets.

Methods: From the local electronic database we extracted all HIV-infected patients with at least one contact with HIV Clinic between 2012 and 2018 excluding deceased and transferred patients.

Our definition of LTFU was based on the lack of any visit during at least 1 year after the last visit. Patients re-engaged were defined as those firstly considered as LTFU patients who subsequently were newly linked to HIV care.

Results: About 8% of patients were lost to follow up during the period of study, with a rate of less than 2% per year and 14.1% of them were re-engaged in care. The cascade of care shows, among HIV cases diagnosed between 2011 and 2018, 86.7% patients retained in care, 94.1% of whom were on cART and 95.6% of whom were virologically suppressed.

A higher attrition was found among infections diagnosed since 2011 than before 2011, such as women, patients coming from foreign countries and those with poor virological control.

Conclusions: The retention rate found in our cohort is high and is in accordance with the 90–90–90 strategy. Nevertheless, understanding disengagement and re-engagement determinants is important to strengthen retention in care in the most fragile population.     

Resilience and Beliefs in the Effectiveness of Current Antiretroviral Therapies Among Recently Disengaged Low-Income People of Color Living with HIV

Abstract

Consistent antiretroviral adherence is key to viral suppression, but many low-income people of color living with HIV are not optimally adherent due to a wide variety of interrelated social and structural factors. Previous studies have found that HIV medication beliefs are an important facet of adherence. In contrast to the AZT era?, currently available antiretroviral therapies are significantly safer and more effective, but research suggests that negative beliefs may persist among racial and ethnic minority people. Twenty-seven semi-structured interviews were conducted with low-income Black and Latinx people living with HIV in New York City that were currently, or had been recently, disengaged from outpatient HIV medical care. This research suggests that socially and economically marginalized people living with HIV, many long-term survivors who lived through the AZT era, recognized that current treatments are very effective in making HIV a chronic, manageable illness and a significant improvement compared to the therapies early in the epidemic. Most importantly, the data suggests that people demonstrate great resilience despite their experiences of social and economic exclusion. Both clinical practice and public health interventions can benefit from these findings. HIV care providers should speak with patients about their beliefs related to HIV medication, and public health interventions should specifically address HIV medication-related beliefs in order to enhance adherence. In order to avoid reifying people’s marginalization, public health should endeavor to recognize and support people’s resilience.     

The relationship between genotypic sensitivity score and treatment outcomes in late stage HIV disease after supervised HAART

This study investigated the effect of resistance testing quantified through a genotypic sensitivity score (GSS) on virologic, immunologic, and clinical responses among patients with late stage HIV‐1 disease receiving supervised highly active antiretroviral therapy (HAART). Newly admitted patients received drug resistance testing (n = 198) and then HAART supervised by residential health‐care facilities nurses. After initiating a resistance testing‐informed HAART regimen, patients were followed for HIV‐1 RNA suppression (<50 copies/ml), mean change in CD4⁺ T‐cells, new AIDS defining category C opportunistic conditions and death. GSS was constructed using the HAART regimen prescribed after resistance testing and data derived from IAS‐USA consensus mutations table with modification. Regressions with generalized estimating equations for robust estimation of standard errors and Cox proportional hazards regression estimated independent associations between GSS and treatment responses. After adjusting for adherence, initial log₁₀ HIV‐1 RNA levels, and other covariates, patients with a GSS ≥3 had significantly greater HIV‐1 RNA suppression (adjusted odds ratio (AOR) 2.32; 95% CI 1.14, 4.75). HIV‐1 RNA levels were lower among patients with ≥95% adherence, but the effect of GSS on viral suppression was not modified by adherence. Self‐rated health status, and baseline CD4⁺ T‐cell counts independently predicted HIV‐1 RNA suppression. GSS did not predict mean change in CD4⁺ cells/mm³ (236 vs. 233, P = 0.92), occurrence of new AIDS defining category C conditions or death. These data support resistance testing‐guided therapy as an independent predictive factor to improve virologic responses in treatment‐experienced patients. J. Med. Virol. 81:1323–1335, 2009. © 2009 Wiley‐Liss, Inc.     

Study of the Validity of a Questionnaire to Assess the Adherence to Therapy in Patients Infected by HIV

Abstract

Purpose: The purpose of our study was to examine the validity of a questionnaire to detect nonadherence in HIV-infected patients under antiretroviral treatment. Method: This was a cross-sectional study to validate a diagnostic test. Participants consisting of 242 HIV-infected patients were elected by consecutive sampling in a hospital in Madrid. The validation standard was the pharmacy dispensing records with the cut point being 80% and 90% of delivered drugs. Sensitivity (S), specificity (SP), positive predictive value (PPV), and positive likelihood ratio (PLR) of the questionnaire were estimated. Results: The mean age of the participants was 36.2 years old (SE 0.42), 55% were men, and 68.2% had used parenteral drugs. Eighty-three patients (34.3%) did not reach 80% of the prescribed dose and 129 patients (53.3%) did not reach 90%. In the 80% group, S was 25.3% (95% CI, 16.7%-36.2%),SP was 86.2% (95% CI, 79.6%-90.9%), PPV was 48.9% (95% CI, 33.5%-64.3%), and the PLR was 1.83 (95% CI, 1.07-3.13). In the 90% group, the S was 19.4% (95% CI, 13.4%-27.4%), SP was 84.0% (95% CI, 75.7%-90.0%), PPV was 58.1% (95% CI, 42.4%-72.6%), and PLR was 1.22 (95% CI, 0.70-2.12). Conclusion: The proposed questionnaire is not a reliable diagnostic method to detect nonadherence. It should only be incorporated into the daily clinical practice along with other methods of nonadherence measurement.     

Allocation of family responsibility for illness management in pediatric HIV

Objective The purpose of the study is to describe allocationof responsibility for illness management in families of childrenand adolescents perinatally infected with HIV. Methods Atotal of 123 youth (ages 8–18) and caregivers completedfamily responsibility and medication adherence questionnairesas part of a substudy of Pediatric AIDS Clinical Trials Groupprotocol 219c. Results Approximately one-fourth ofthe youth reported being fully responsible for taking medications.A smaller percentage of caregivers reported full youth responsibility.Older youth and caregivers of older youth reported higher degreeof youth responsibility for medication-related tasks, thoughage was unrelated to adherence. Caregiver report of greaterresponsibility for medications was associated with better adherence. Conclusions Caregiversare likely to transition responsibility for HIV care to olderyouth but this transition was not always successful as evidencedby poor medication adherence. Interventions supporting successfultransition may improve adherence and subsequently health outcomesin pediatric HIV.     

Barriers to HIV Medication Adherence: Examining Distinct Anxiety and Depression Symptoms among Women Living with HIV Who Experienced Childhood Sexual Abuse

Experiencing sexual violence in childhood or adolescence is highly prevalent among some women living with HIV, often resulting in anxiety and depression symptoms in adulthood. Anxiety and depression have been associated with HIV medication nonadherence, yet little research has assessed distinct components of anxiety and depression as risk factors of HIV medication nonadherence. The current study examined distinct symptom components of anxiety and depression as predictors of HIV medication non-adherence among women living with HIV and childhood sexual abuse enrolled in a coping intervention. This secondary analysis included a sample of 85 women living with HIV and childhood sexual abuse and being prescribed antiretroviral medication who completed measures on anxiety, depression, and medication adherence. Results from a logistic regression analysis suggest that distinct components of anxiety may be related to medication nonadherence among this population. Targeted mental health interventions for this population may increase adherence to antiretroviral medication.