Center of Infectious Diseases, Research Center of Clinical Epidemiology and Evidence-Based Medicine, Innovation Insititute for Integration of Medicine and Engineering, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, People's Republic of China.
Sichuan Center for Disease Control and Prevention, Chengdu, 610041, Sichuan, People's Republic of China.
Infect Dis Poverty. 2024 Jul 5;13(1):51. doi: 10.1186/s40249-024-01221-4.
Given the critical importance of medication adherence in HIV/AIDS treatment, this study aims to compare medication adherence measured by self-report (SR) and indirect measurement among antiretroviral therapy (ART) patients, exploring the differences of adherence results measured by different tools.
We systematically searched PubMed, Embase, and the Cochrane Library to identify all relevant literature published up to November 22, 2023, without language restrictions, reporting adherence to ART measured by both SR and indirect measurement methods, while also analyzing individual and group adherence separately. Discrepancies between SR and indirect measurement results were assessed using the Mann-Whitney U test or Wilcoxon signed-rank test, with correlations evaluated using the Pearson correlation coefficient. Following one-to-one comparisons, meta-epidemiological one-step analysis was conducted, and network meta-analysis techniques were applied to compare results obtained through specific adherence assessment tools reported in the identified articles.
The analysis encompassed 65 original studies involving 13,667 HIV/AIDS patients, leading to 112 one-to-one comparisons between SR and indirect measurement tools. Statistically significant differences were observed between SR and indirect measurement tools regarding both individual and group adherence (P < 0.05), with Pearson correlation coefficients of 0.843 for individual adherence and 0.684 for group adherence. During meta-epidemiological one-step analysis, SR-measured adherence was determined to be 3.94% (95% CI: -4.48-13.44%) higher for individual adherence and 16.14% (95% CI: 0.81-18.84%) higher for group adherence compared to indirectly measured results. Subgroup analysis indicated that factors such as the year of reporting and geographic region appeared to influence the discrepancies between SR and indirect measurements. Furthermore, network meta-analysis revealed that for both individual and group adherence, the results obtained from most SR and indirect measurement tools were higher than those from electronic monitoring devices, with some demonstrating statistical significance (P < 0.05).
The findings underscored the complexity of accurately measuring medication adherence among ART patients. Significant variability was observed across studies, with self-report methods showing a significant tendency towards overestimation. Year of reporting, geographic region, and adherence measurement tools appeared to influence the differences between SR and indirect measurements. Future research should focus on developing and validating integrated adherence measurements that can combine SR data with indirect measures to achieve a more comprehensive understanding of adherence behaviors.
鉴于药物依从性在 HIV/AIDS 治疗中的重要性，本研究旨在比较抗逆转录病毒治疗 (ART) 患者中自我报告 (SR) 和间接测量两种方法测量的药物依从性，探讨不同工具测量的依从性结果的差异。
我们系统地检索了 PubMed、Embase 和 Cochrane 图书馆，以确定截至 2023 年 11 月 22 日发表的所有相关文献，不限制语言，报告了通过 SR 和间接测量方法测量的 ART 依从性，同时分别分析个体和群体的依从性。使用 Mann-Whitney U 检验或 Wilcoxon 符号秩检验评估 SR 和间接测量结果之间的差异，使用 Pearson 相关系数评估相关性。在一对一比较之后，进行了元流行病学一步分析，并应用网络荟萃分析技术比较了从确定的文章中报告的特定依从性评估工具获得的结果。
分析共纳入了 65 项原始研究，涉及 13667 名 HIV/AIDS 患者，导致 SR 和间接测量工具之间进行了 112 次一对一比较。个体和群体依从性方面，SR 和间接测量工具之间存在显著差异（P<0.05），个体依从性的 Pearson 相关系数为 0.843，群体依从性的 Pearson 相关系数为 0.684。在元流行病学一步分析中，与间接测量结果相比，SR 测量的个体依从性高 3.94%（95%CI：-4.48-13.44%），群体依从性高 16.14%（95%CI：0.81-18.84%）。亚组分析表明，报告年份和地理区域等因素似乎影响了 SR 和间接测量之间的差异。此外，网络荟萃分析显示，对于个体和群体依从性，大多数 SR 和间接测量工具的结果均高于电子监测设备的结果，其中一些结果具有统计学意义（P<0.05）。
研究结果强调了准确测量 ART 患者药物依从性的复杂性。研究之间存在显著差异，自我报告方法存在明显的高估趋势。报告年份、地理区域和依从性测量工具似乎影响了 SR 和间接测量之间的差异。未来的研究应集中于开发和验证综合的依从性测量方法，将 SR 数据与间接测量相结合，以更全面地了解依从性行为。
