Liu Honghu, Miller Loren G, Hays Ron D, Wagner Glenn, Golin Carol E, Hu Wenhua, Kahn Katherine, Haubrich Richard, Kaplan Andrew H, Wenger Neil S
Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA 90095-1736, USA.
J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S104-12. doi: 10.1097/01.qai.0000245888.97003.a3.
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.
Longitudinal cohort design.
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.
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).
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.
在临床环境中，抗逆转录病毒药物依从性的自我报告成本低廉且使用简便，但却严重高估了依从性。我们研究了校准患者自我报告的依从性的方法，以便更紧密地匹配客观测量的依从性，目的是开发一种实用且更准确的自我报告依从性测量方法。
纵向队列设计。
利用在5家艾滋病诊所进行的2项前瞻性纵向临床研究的数据，我们检查了自我报告的依从性与客观测量的依从性之间的差异。我们评估了态度测量与差异程度之间的关系，并采用交叉验证方法提出候选项目，以改进依从性调查方法。
在330名患者中，自我报告的依从性始终高于客观测量的依从性。最佳校准模型包括患者自我报告的依从性、抗逆转录病毒治疗方案的持续时间以及态度测量（按指示服药的能力、相信药物有助于延长寿命、服用抗逆转录病毒药物是否过于麻烦以及感觉事情进展是否顺利）。
该方法有效地识别了调查项目，以改进自我报告的依从性测量。校准后的测量更接近客观测量的依从性，并且在检测不依从方面更敏感。这些模型值得在其他环境中进行评估。
