Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 406 Babbidge Road, Storrs, CT, 06269, USA.
Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
J Behav Med. 2024 Feb;47(1):135-143. doi: 10.1007/s10865-023-00438-2. Epub 2023 Jul 31.
Patient-report instruments remain the most feasible and sustainable approaches for monitoring medication adherence in clinical settings. However, questions of their reliability and validity persist. Studies suggest that the 3-item instrument for retrospective adherence (IRA) developed by Wilson et al. offers a viable option for clinically monitoring medication adherence. Here we report the reliability and validity of the IRA among patients recruited from community-based HIV clinics and antiretroviral therapy (ART) dispensaries in a resource constrained township in Cape Town, South Africa.
Women (n = 794) and men (n = 228) receiving ART completed the IRA at three time points: (a) in a face-to-face administration at enrollment (b) in1-week phone interview and (c) 1-month phone interview. Participants also provided contemporaneous blood samples for HIV viral load testing as a clinical outcome and unannounced phone-based pill counts as an objective assessment of ART adherence.
The IRA was internally consistent and showed evidence of time stability. The IRA also demonstrated validity with respect to pill count adherence, correlates of adherence, and HIV viral load. Response operating curve analysis yielded an area under the curve of 0.646, using 75% adherence as the cut-off, with 0.637 sensitivity and 0.567 specificity.
The IRA demonstrated reliability, construct validity and criterion validity in a resource constrained setting, supporting use of the IRA in research and clinical care.
患者报告工具仍然是监测临床环境中药物依从性最可行和可持续的方法。然而，其可靠性和有效性问题仍然存在。研究表明，Wilson 等人开发的用于回顾性依从性的 3 项工具（IRA）为临床监测药物依从性提供了一种可行的选择。在这里，我们报告了在南非开普敦资源有限的乡镇的社区 HIV 诊所和抗逆转录病毒治疗 (ART) 药房招募的患者中 IRA 的可靠性和有效性。
接受 ART 的女性（n=794）和男性（n=228）在三个时间点完成了 IRA：(a) 在入组时进行面对面管理；(b) 在 1 周的电话访谈中；(c) 在 1 个月的电话访谈中。参与者还同时提供了 HIV 病毒载量检测的血液样本作为临床结果和未经宣布的基于电话的药丸计数作为 ART 依从性的客观评估。
IRA 具有内部一致性，并显示出时间稳定性的证据。IRA 还在药丸计数依从性、依从性相关因素和 HIV 病毒载量方面具有有效性。响应操作曲线分析得出的曲线下面积为 0.646，使用 75%的依从性作为截止值，灵敏度为 0.637，特异性为 0.567。
IRA 在资源有限的环境中表现出可靠性、结构有效性和标准有效性，支持在研究和临床护理中使用 IRA。
