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Provider Estimate and Structured Patient Report of Adherence Compared with Unannounced Pill Count D. R. BANGSBERG*, F. M. HECHT, H. CLAGUE, E. CHARLEBOIS, D. CICCARONE, M. CHESNEY, and A. R. MOSS.
Univ. of California, San Francisco
Background: Adherence (Ad) assessment is an essential component
of monitoring HAART.
Objective: Determine the accuracy of PE and SPR of nonadherence
(NAd) to HAART compared to UPC.
Design: Cross-sectional analysis of patients on HAART (n=45) and
their providers (n=35) in the REACH cohort.
Measurements: PE of % pills taken; three successive SPR of number
of doses missed in the last three days; and % Ad determined by 3 successive
UPC at the subjects' place of residence over 2 months.
Results: PE explained only 26% of the variation in UPC (Fig 1),
while SPR explained 72% (Fig 2). The sensitivity and specificity of PE
of NAd (>20% missed pills) were =40% and 85% respectively. The negative
predictive value of PE of NAd was 53%. SPR was more sensitive (72%) and
more specific (95%) than PE. Findings were confirmed with repeated measures
analysis.
Conclusions: PE was inaccurate, while SPR was closely related to
UPC. Almost half of the patients thought to be Ad by their providers were
NAd by UPC. SPR over several short intervals may improve the accuracy
of Ad assessment in routine clinical practice.
Key Words: adherence, HAART, provider
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