Adherence to Antiretroviral Therapy: Appropriate Use of Self-Reporting in Clinical Practice

Abstract

PURPOSE: This study investigated the factors that may affect adherence to antiretroviral therapy in people with HIV infection and compared the use of three self-report tools to determine client adherence. METHOD: A descriptive, cross-sectional study of 260 HIV-infected clients attending nine HIV outpatient centers in England was conducted using researcher-administered instruments. Self-reports of adherence were assessed using the Morisky Medication Adherence Scale (MMAS), Reported Adherence to Medication Scale (RAM), and the Patient Adjustment to Medication Scale (PAM). RESULTS: Univariate analysis of clients' self-reports indicated a number of associations with adherence. Significant associations with less adherent behavior identified by two or more self-report tools were the reported use of recreational drugs, p =.001; living alone, p =.041; feeling depressed, p =.02; being influenced by the media, p =.037; and lack of a close confidant, p =.037. Greater adherence was associated with clients reporting a positive mental attitude to HIV infection, p =.038. Principal component analysis (PCA) of each self-report tool identified two well-recognized constructs: intentional nonadherence and unintentional nonadherence. In addition, a third construct of following instructions was identified from PAM, a scale developed by the authors. Subsequent regression analysis failed to confirm the associations with adherence suggested by the univariate analysis. CONCLUSION: This study suggests that the design and use of self-report tools to identify client's adherence to complex antiretroviral regimens may need to measure individual constructs of adherence to accurately assess adherence behavior.