Agreement between ARV Adherence in self-report and lab data in Engagement Open Access

Abstract

Antiretroviral (ARV) adherence is critical in preventing the transmission of HIV. Among populations disproportionately affected by HIV, the Men who have Sex with Men (MSM) population accounts for most of the individuals living with HIV in the United States. Inconsistent ARV adherence presents a challenge for accurately measuring adherence through self-report measurements. This longitudinal cohort study compared self-reported ARV adherence to serum ARV detection among 400 MSM in Atlanta. Demographic characteristics and self-reported information on HIV medication use and continuity of HIV care was ascertained through structured questions on retention in care, HIV treatment, adherence, and HIV care services received via computer-assisted self-interviewing (CASI) surveys. Overall average agreement was highest for HIV treatment and lowest for retention in HIV care, with agreement ranging from kappa values of 0.08 (≥ 3 visits to outpatient HIV medical care in the past 12 months) to 0.65 (currently taking HIV medications). Participants who reported currently taking HIV medications had substantial agreement with corresponding laboratory data (Κ=0.65, 95% CI: 0.53, 0.77). Race, annual income, and currently receiving treatment for anxiety or depression were significantly associated with lab-reported non-adherence of HIV medications among participants who self-reported high adherence to HIV medications. Although our survey was specifically designed for MSM living with HIV, only one self-reported measurement of adherence substantially agreed with corresponding objective measures of ARV adherence, suggesting that relying solely on self-report may not be accurately representing ARV adherence among the MSM population and could increase the likelihood of overestimating ARV adherence levels. The results of this analysis show that self-reported adherence to ARV regimens was high when assessed by laboratory analysis.

Table of Contents

Introduction…………………………………………………………………………………..……1

Methods……………………………………………………………………..……………………..4

Results……………………………………………………………………………….……….…….6

Discussion…………………………………………………………………..……………………..8

References…………………………………………………………….……….…………………13

Table 1……………………………………………………….…………………………………...18

Table 2…………………………….……………………………………………………….….….20

Table 3……………………………….…………………………………….………………….….21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Epidemiology GLBT Studies
Keyword	Adherence Discordance MSM Antiretroviral HIV ARV Adherence
Committee Chair / Thesis Advisor	Jodie Guest, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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