Main Organiser

Julius Centre University of Malaya

Co-organiser

Department of Social and Preventive Medicine, Faculty of Medicine, University of Malay

Supported by

University of Malaya

HOW WELL DOES SELF-REPORTED ADHERENCE FARE IN RELATION TO THERAPEUTIC DRUG MONITORING IN HAART?

Author

Bulgiba AM, Mohammed UY, Chik Z, Lee C, Peramalah D

Institution

Julius Centre, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya

Abstract

Objectives: To determine whether self-reported adherence can be used for monitoring HAART adherence.

Methods: We administered self-reported adherence questionnaires to 925 participants during a prospective cohort study of 925 HIV patients on HAART in a large Malaysian hospital from 2010-11. Therapeutic drug monitoring (TDM) was performed by collecting and testing blood samples for Efavirenz, Nevirapine and Lamivudine using Liquid Chromatography/Mass Spectrometry. We compared the self-reported adherence against the TDM results. ROC curves, sensitivity, specificity, positive (PPV) and negative predictive (NPV) values were computed for each drug.

Results: The overall adherence level as measured by self-reported questionnaire was 81.7%. Self- reported adherence had a sensitivity of >80% for Efaviranz, Nevirapine and >70% for Lamivudine; and specificity of >70% for all 3 drugs. PPV was >90% for all 3 drugs while NPV was >50% for all 3 drugs. Self-reported adherence had an AUC of 0.834 (95% CI 0.781, 0.887) for Efaviranz, 0.771 (95% CI 0.711, 0.831) for Nevirapine and 0.758 (95% CI 0.696, 0.820) for Lamivudine.

Conclusion: Self-reported adherence is a surprisingly accurate instrument for measuring HAART adherence compared to TDM and can be reliably used in practice.