How well does self-reported adherence fare compared to therapeutic drug monitoring in HAART?

Bulgiba, A. and Mohammed, U.Y. and Chik, Z. and Lee, C. and Peramalah, D. (2013) How well does self-reported adherence fare compared to therapeutic drug monitoring in HAART? Preventive medicine. ISSN 0091-7435, DOI https://doi.org/10.1016/j.ypmed.2013.01.002.

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Abstract

Objective: The aim of the study was to determine how well self-reported adherence fares compared to therapeutic drug monitoring in monitoring HAART adherence. Methods: We administered a validated self-reported adherence (SRA) questionnaire to 925 HIV patients on HAART in a large Malaysian hospital from 2010 to 11. We also performed Therapeutic Drug monitoring (TDM) by concurrently collecting and testing blood samples for Efavirenz, Nevirapine and Lamivudine using Liquid Chromatography/Mass Spectrometry. We compared the SRA against the TDM results. Sensitivity, specificity, positive (PPV) and negative predictive (NPV) and diagnostic accuracy values were computed for each drug. Results: Self-reported adherence (SRA) over-estimates adherence by between 6 and 10 percentage points compared to therapeutic drug monitoring (TDM). SRA is highly sensitive with sensitivity exceeding 0.90 but is not very specific (0.56�0.63). PPV for SRA ranged between 0.76 (Lamivudine) and 0.84 (Efavirenz) while NPV ranged between 0.78 (Lamivudine) and 0.81 (Efavirenz). Overall diagnostic accuracy ranged between 0.76 (Lamivudine) and 0.84 (Nevirapine). Conclusion: Self-reported adherence is a surprisingly accurate instrument for measuring HAART adherence compared to TDM and can be reliably used in practice in resource-poor settings.

Item Type: Article
Funders: UNSPECIFIED
Additional Information: Department of Social and Preventive Medicine, Faculty of Medicine Building, University of Malaya, 50603 Kuala Lumpur, MALAYSIA
Uncontrolled Keywords: Self-reported adherence; HAART; Therapeutic drug monitoring; HIV
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms Haslinda Lahuddin
Date Deposited: 20 Aug 2013 01:11
Last Modified: 20 Aug 2013 01:11
URI: http://eprints.um.edu.my/id/eprint/8288

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