ArticleAIDS patient care and STDs2011
Validating five questions of antiretroviral nonadherence in a public-sector treatment program in rural South Africa.
Article in AIDS patient care and STDs, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 4 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Measurement Properties of Existing Patient-Reported Outcome Measures on Medication Adherence: Systematic Review.Journal of medical Internet research · 2020Pooled it
- Development of an Item Bank to Measure Medication Adherence: Systematic Review.Journal of medical Internet research · 2020Pooled it
- Representation of women and pregnant women in HIV research: a limited systematic review.PloS one · 2013Pooled it
- Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies.The Lancet. Infectious diseases · 2011Pooled it
- Dental caries in association with viral load in children living with HIV in Phnom Penh, Cambodia: a cross-sectional study.BMC oral health · 2021Trial
- Short Communication: Early Antiretroviral Therapy Is Associated with Better Viral Suppression and Less HIV Drug Resistance After Implementation of Universal Treatment in South Africa.AIDS research and human retroviruses · 2020Trial
- Trial
- Impact of differentiated care service delivery systems on adherence among the HIV-positive patients receiving antiretroviral therapy in a Southeastern Nigerian State.AIDS research and therapy · 2025Article
- Exploring Self-reported Adherence Measures to Screen for Elevated HIV Viral Load in Adolescents: A South African Cohort Study.AIDS and behavior · 2023Article
- Association of oral health status with the CD4+ cell count in children living with HIV in Phnom Penh, Cambodia.Scientific reports · 2019Article
- HIV viraemia during pregnancy in women receiving preconception antiretroviral therapy in KwaDukuza, KwaZulu-Natal.Southern African journal of HIV medicine · 2019Article
- Effect of the Number of Pregnancies on Mortality Risk in HIV-Infected Women: a Prospective Cohort Study in Rural KwaZulu-Natal, South Africa.AIDS and behavior · 2018Article
- Patient satisfaction and treatment adherence of stable human immunodeficiency virus-positive patients in antiretroviral adherence clubs and clinics.African journal of primary health care & family medicine · 2018Article
- Adherence to antiretroviral therapy for HIV in sub-Saharan Africa and Asia: a comparative analysis of two regional cohorts.Journal of the International AIDS Society · 2017Article
- A Self-Reported Adherence Measure to Screen for Elevated HIV Viral Load in Pregnant and Postpartum Women on Antiretroviral Therapy.AIDS and behavior · 2017Article
- Innovations in health and demographic surveillance systems to establish the causal impacts of HIV policies.Current opinion in HIV and AIDS · 2015Review
- Addressing social issues in a universal HIV test and treat intervention trial (ANRS 12249 TasP) in South Africa: methods for appraisal.BMC public health · 2015Article
- Development of an electronic medical record based alert for risk of HIV treatment failure in a low-resource setting.PloS one · 2014Article
- Article
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Authors and funding
5 authors.
Funding
Abstract
Simple questions are the most commonly used measures of antiretroviral treatment (ART) adherence in sub-Saharan Africa (SSA), but rarely validated. We administered five adherence questions in a public-sector primary care clinic in rural South Africa: 7-day recall of missed doses, 7-day recall of late doses, a six-level Likert item, a 30-day visual analogue scale of the proportion of doses missed, and recall of the time when an ART dose was last missed. We estimated question sensitivity and specificity in detecting immunologic (or virologic) failure assessed within 45 days of the adherence question date. Of 165 individuals, 7% had immunologic failure; 137 individuals had viral loads with 9% failure detected. The Likert item performed best for immunologic failure with sensitivity/specificity of 100%/5% (when defining nonadherence as self-reported adherence less than "excellent"), 42%/55% (less than "very good"), and 25%/95% (less than "good"). The remaining questions had sensitivities ≤17%, even when the least strict cutoffs defined nonadherence. When we stratified the analysis by gender, age, or education, question performance was not substantially better in any of the subsamples in comparison to the total sample. Five commonly used adherence questions performed poorly in identifying patients with treatment failure in a public-sector ART program in SSA. Valid adherence measurement instruments are urgently required to identify patients needing treatment support and those most at risk of treatment failure. Available estimates of ART adherence in SSA are mostly based on studies using adherence questions. It is thus unlikely that our understanding of ART adherence in the region is correct.
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