Evaluation of multiple measures of antiretroviral adherence in the Eastern European country of Georgia

• Type of Material: Article
• Authors: Nikoloz Chkhartishvili, AIDS and Clinical Immunology Research Center; Nino Rukhadze, AIDS and Clinical Immunology Research Center; Mariam Svanidze, AIDS and Clinical Immunology Research Center; Lali Sharvadze, AIDS and Clinical Immunology Research Center; Jack A. Dehovitz, SUNY Downstate Medical Center; Tengiz Tsertsvadze, AIDS and Clinical Immunology Research Center; Louis-Anne McNutt, University at Albany State University of New York; Carlos Del Rio, Emory University
• Language: English
• Date: 2014-04-09
• Publisher: BioMed Central
• Publication Version: Final Published Version
• Copyright Statement: © 2014 Chkhartishvili N et al; licensee International AIDS Society
• License: Creative Commons Attribution 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.7448/IAS.17.1.18885
• Title of Journal or Parent Work: Journal of the International AIDS Society
• ISSN: 1758-2652
• Volume: 17
• Issue: 1
• Start Page: 18885
• End Page: 18885
• Grant/Funding Information: This study was supported in part by the US National Institutes of Health/Fogarty International Center (Emory AIDS International Training and Research Program, grant #D43 TW01042; and the New York State International Training and Research Program grant #D43 TW000233).
• Keywords: viral suppression; Adult; Visual Analog Scale; Self Report; injection drug use; Viral Load; Medication Adherence; ROC Curve; Georgia (Republic); Eastern Europe; antiretroviral therapy; CD4 Lymphocyte Count; Male; Prospective Studies; HIV Infections; Humans; adherence; Female; Anti-HIV Agents
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Introduction: There is little information on adherence to antiretroviral therapy (ART) in the Eastern European region. This prospective study evaluated multiple measures of adherence and their association with viral suppression among HIV patients in Georgia. Methods: A prospective cohort study enrolled 100 consecutive antiretroviral-naïve adult (age ≥18 years) patients, who were followed for three months. Adherence was assessed by medication refill and three self-report measures (an AIDS Clinical Trial Group [ACTG] tool for four-day adherence, a visual analogue scale [VAS] and a rating task for 30-day adherence). The VAS represented a line anchored by 0 and 100% corresponding to the percentage of prescribed doses taken. The rating task asked patients to rate their ability to take all medications as prescribed, with responses categorized into six levels of adherence: very poor (0%), poor (20%), fair (40%), good (60%), very good (80%) and excellent (100%). Patients with adherence of ≥95% by medication refill, ACTG and VAS, and ≥80% by rating task, were defined as adherent. Results: Of 100 patients enrolled, eight had missing data and were excluded from analysis. Among the remaining 92 patients, the median age was 39 years, and 70% were men. Major modes of HIV acquisition were injection drug use (IDU; 47.3%) and heterosexual contact (44.1%). The proportions of adherent patients were as follows: 68% by medication refill, 90% by ACTG questionnaire, 38% by VAS and 42% by rating task. On average, four months after commencing ART, 52 (56.5%) patients had a viral load < 400 copies/ml and 26 (28.3%) patients had a viral load < 50 copies/ml. Of 43 persons with a history of IDU, 22 (51.2%) reached a viral load of < 400 copies/ml. In multivariate analysis, only refill adherence was a statistically significant predictor of viral suppression of < 400 copies/ml: the risk ratio was 1.7 (95% CI: 1.1-2.8). Refill adherence, VAS and rating task were associated with viral suppression of < 50 copies/ml. Non-IDUs were twice as likely to achieve viral load < 50 copies/ml compared to IDUs. Refill adherence had the largest area under the receiver-operating characteristic curve for predicting viral suppression. Conclusions: Medication refill adherence was the strongest predictor of viral suppression. IDUs can achieve optimal virologic outcomes, but may require additional adherence support. © 2014 Chkhartishvili N et al; licensee International AIDS Society.