Comparing Self-Reports, Pill Counts, and Electronic Devices in Assessing Antiretroviral Therapy Adherence and its Association With Viral Suppression in Adolescents Living With HIV
Journal of Acquired Immune Deficiency Syndromes
Authors: Samuel Kizito, Fred M Ssewamala, Josephine Nabayinda, Proscovia Nabunya, Ozge Sensoy Bahar, Phionah Namatovu & Torsten B Neilands
In this study, the investigators compared three methods of measuring antiretroviral therapy (ART) adherence and examined their relationship with viral suppression among adolescents living with HIV (ALHIV) in southern Uganda. The study used baseline data from 702 adolescents aged 10–16 years receiving ART across 39 clinics in the Greater Masaka region. ART adherence was assessed using three approaches: a three-item self-report measure, unannounced pill counts, and electronic monitoring with Wisepill, which recorded medication-container openings over a 30-day period. The investigators evaluated agreement among adherence measures and their ability to distinguish adolescents who were virally suppressed, using sensitivity, specificity, receiver operating characteristic (ROC) curves, and multilevel logistic regression.
Approximately 73% of participants reported ≥90% ART adherence, whereas 67.1% achieved viral suppression. The three adherence measures demonstrated only moderate agreement, with agreement coefficients ranging from 0.410 between self-report and Wisepill to 0.545 between pill counts and Wisepill. Furthermore, all three measures showed limited ability to discriminate between adolescents with and without viral suppression, with area under the ROC curve (AUC) values ranging from 0.560 for pill counts to 0.616 for self-reported adherence. In multilevel regression analyses, only self-reported adherence was significantly associated with viral suppression (OR=2.16, 95% CI: 1.25–3.81; P=0.006).
The findings demonstrated substantial discrepancies between commonly used ART adherence measures. Although low self-reported adherence may help identify adolescents at increased risk of virologic failure, high self-reported adherence did not reliably indicate viral suppression. The study therefore highlighted limitations in relying on a single adherence measure and underscored the importance of considering objective measures and viral load monitoring when evaluating ART adherence among adolescents living with HIV.