Department of Psychiatry, University of California, San Diego, School of Medicine, La Jolla, California, USA.
AIDS Patient Care STDS. 2012 Jul;26(7):388-94. doi: 10.1089/apc.2011.0447. Epub 2012 Jun 11.
Assessing medication adherence in already difficult-to-treat HIV-infected subpopulations presents a unique challenge. The objective of this study was to compare different approaches to assessing medication adherence: (1) electronic medication monitoring, (2) standardized self-report questionnaire, and (3) self-report visual analogue scale, and to determine whether antiretroviral therapy (ART) adherence measures differed for HIV-infected persons with bipolar disorder (HIV+ /BD+) as compared to HIV-infected persons without bipolar disorder (HIV+ /BD-). ART adherence was assessed for 74 HIV-positive participants using the Medication Event Monitoring System (MEMS), AIDS Clinical Trials Group (ACTG) adherence questionnaire, and visual analogue scale (VAS). Participants were classified as adherent or nonadherent on each measure by previously validated cutscores. Correlations and logistic regressions were used to examine associations between adherence measures and demographic and clinical variables. In the HIV+ /BD- group, significant correlations existed between each self-report measure and the MEMS. Males comprised 81% of the study population. Participants averaged 44 years of age and 13 years of education. No significant correlations were found among adherence measures in the HIV+ /BD+ group. Among participants reporting adherence on either self-report measure but classified as nonadherent based on MEMS, 94% had a diagnosis of bipolar disorder. Bipolar disorder was a significant predictor of adherence classification discordance among self-report measures. Our findings suggest that it remains difficult to assess ART adherence among HIV-positive individuals with bipolar disorder. Combined approaches of self-report and objective measures may be the best way to estimate adherence, and may provide the best basis for interventions designed to improve adherence in difficult-to-treat populations.
评估已经难以治疗的 HIV 感染亚人群的药物依从性提出了一个独特的挑战。本研究的目的是比较评估药物依从性的不同方法：（1）电子药物监测，（2）标准化自我报告问卷，和（3）自我报告视觉模拟量表，并确定抗逆转录病毒治疗（ART）依从性测量是否因感染 HIV 的双相情感障碍患者（HIV + / BD +）与未感染 HIV 的双相情感障碍患者（HIV + / BD-）而有所不同。使用药物事件监测系统（MEMS）、艾滋病临床治疗试验组（ACTG）依从性问卷和视觉模拟量表（VAS）评估了 74 名 HIV 阳性参与者的 ART 依从性。参与者根据先前验证的切割分数被归类为依从或不依从。使用相关性和逻辑回归来检查依从性测量与人口统计学和临床变量之间的关联。在 HIV + / BD-组中，每个自我报告测量与 MEMS 之间存在显著相关性。男性占研究人群的 81%。参与者的平均年龄为 44 岁，受教育程度为 13 年。在 HIV + / BD+组中，没有发现依从性测量之间存在显著相关性。在报告两种自我报告测量中的任何一种依从性但根据 MEMS 被归类为不依从的参与者中，94%患有双相情感障碍。双相情感障碍是自我报告测量中依从性分类不一致的显著预测因素。我们的研究结果表明，评估患有双相情感障碍的 HIV 阳性个体的 ART 依从性仍然具有挑战性。自我报告和客观测量相结合的方法可能是评估依从性的最佳方法，并且可能为旨在改善难以治疗人群的依从性的干预措施提供最佳依据。
