Global Health Collaborative, Mbarara University of Science and Technology, Mbarara.
Infectious Diseases Institute, Makerere University, Kampala, Uganda.
AIDS. 2018 Sep 24;32(15):2237-2245. doi: 10.1097/QAD.0000000000001955.
Short messaging service (SMS) can collect adherence data on a frequent basis and is relatively anonymous, and therefore could potentially reduce recall and social desirability biases prevalent in other self-reported measures.
We compared SMS self-reported adherence with three self-reported adherence questions (rating of ability to adhere, frequency of doses taken, percentage of doses taken) and two objective adherence measures [electronic adherence monitoring (EAM) and plasma tenofovir levels] using data from HIV-uninfected members of serodiscordant couples enrolled in a preexposure prophylaxis demonstration project in Kenya and Uganda.
Of 373 enrolled participants, 256 (69%) were male and median age at enrolment was 29 years (26, 35). Fifty-two percent were from Kenya and median education at enrolment was 10 years (7,12). Overall, median adherence was 90, 75, 85, 94 and 79%, respectively, for self-report by SMS, rating, frequency, percentage and EAM adherence. Spearman's correlation coefficient between SMS and interviewer-administered self-reported measures was 0.18 for rating and frequency, 0.22 for percentage and 0.14 for EAM (all P < 0.001). The estimated difference in average adherence between SMS and self-reported rating, frequency, percentage adherence and EAM was 8.1 (P < 0.001), 0.3 (P = 0.81), -5.2 (P < 0.001) and 9.5 (P < 0.001), respectively. Area under the receiver-operating curve assessing the ability of SMS self-report to discriminate between detectable and undetectable tenofovir was 0.51.
Our study found low correlation between SMS self-report and other self-reported and objective adherence measures and did not discriminate between detectable and undetectable plasma tenofovir levels. Future use of SMS self-report should explore alternative means for reducing potential biases.
短信息服务（SMS）可以频繁地收集用药依从性数据，并且具有相对匿名性，因此可能会降低其他自我报告措施中普遍存在的回忆偏倚和社会期望偏倚。
我们将 SMS 自我报告的依从性与三个自我报告的依从性问题（对坚持用药能力的评价、服用剂量的频率、服用剂量的百分比）以及两种客观的依从性测量方法（电子依从性监测（EAM）和血浆替诺福韦水平）进行了比较，这些数据来自肯尼亚和乌干达参加暴露前预防示范项目的血清不一致的夫妇中的未感染 HIV 的成员。
在 373 名入组的参与者中，256 名（69%）为男性，入组时的中位年龄为 29 岁（26、35）。52%来自肯尼亚，入组时的中位教育程度为 10 年（7、12）。总体而言，SMS 自我报告、评价、频率、百分比和 EAM 依从性的中位依从率分别为 90%、75%、85%、94%和 79%。SMS 与访谈者管理的自我报告措施之间的 Spearman 相关系数分别为 0.18 用于评分和频率，0.22 用于百分比，0.14 用于 EAM（均 P < 0.001）。SMS 与自我报告的评分、频率、百分比和 EAM 之间的平均依从性估计差异分别为 8.1（P < 0.001）、0.3（P = 0.81）、-5.2（P < 0.001）和 9.5（P < 0.001）。评估 SMS 自我报告区分可检测和不可检测替诺福韦能力的受试者工作特征曲线下面积为 0.51。
我们的研究发现，SMS 自我报告与其他自我报告和客观的依从性措施之间相关性较低，并且不能区分可检测和不可检测的血浆替诺福韦水平。未来使用 SMS 自我报告应探索减少潜在偏倚的替代方法。
