Self-reported adherence is more predictive of virological treatment response among patients with a lower tendency towards socially desirable responding
Free accessAnnouncementFirst published online August, 2010
Self-reported adherence is more predictive of virological treatment response among patients with a lower tendency towards socially desirable responding
Self-report is the most commonly used measure of adherence to highly active antiretroviral therapy, but typically shows weaker associations with virological treatment outcome than more objective adherence assessment methods. Socially desirable responding might hamper the validity of self-reported adherence. We investigated whether stratifying patients according to their socially desirable response set might improve the prediction of virological treatment response by self-reported adherence.
Methods
Patients enrolled in the focus group of the Dutch national cohort ATHENA completed a social desirability scale, four self-report adherence questions, and had their plasma HIV type-1 (HIV-1) RNA concentrations measured. We calculated odds ratios and 95% confidence intervals for self-reported non-adherence to predict HIV-1 RNA>50 copies/ml among patients with a lower or a higher tendency towards socially desirable responding.
Results
A total of 331 patients were included. Self- reported non-adherence was significantly predictive of HIV-1 RNA>50 copies/ml on three out of four questions among patients with lower socially desirable responding (n=198). Self-reported non-adherence did not predict HIV-1 RNA>50 copies/ml among patients with higher socially desirable responding (n=132).
Conclusions
Stratifying patients according to their socially desirable response set improved the prediction of virological treatment response by self-reported adherence. This finding emphasizes the importance of discussing medication adherence with patients in a non-threatening and non-judgemental way that normalizes non-adherence in order to reduce socially desirable responding.
References
1.
PatersonD.L., SwindellsS., MohrJ.Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.Ann Intern Med2000; 133: 21–30.
2.
BangsbergD.R., HechtF.M., CharleboisE.D.Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population.AIDS2000; 14: 357–366.
3.
LiuH., GolinC.E., MillerL.G.A comparison study of multiple measures of adherence to HIV protease inhibitors.Ann Intern Med2001; 134: 968–977.
4.
BergK.M., ArnstenJ.H.Practical and conceptual challenges in measuring antiretroviral adherence.J Acquir Immune Defic Syndr2006; 43 Suppl 1: S79–S87.
5.
WagnerG., MillerL.G.Is the influence of social desirability on patients’ self-reported adherence overrated?J Acquir Immune Defic Syndr2004; 35: 203–204.
6.
PearsonC.R., SimoniJ.M., HoffP., KurthA.E., MartinD.P.Assessing antiretroviral adherence via electronic drug monitoring and self-report: an examination of key methodological issues.AIDS Behav2007; 11: 161–173.
7.
SimoniJ.M., FrickP.A., LockhartD., LiebovitzD.Mediators of social support and antiretroviral adherence among an indigent population in New York City.AIDS Patient Care STDS2002; 16: 431–439.
8.
AlticeF.L., MostashariF., FriedlandG.H.Trust and acceptance of and adherence to antiretroviral therapy.J Acquir Immune Defic Syndr2001; 28: 47–58.
9.
TourangeauR., YanT.Sensitive questions in surveys.Psychol Bull2007; 133: 859–883.
10.
Van SighemA.I., van de WielM.A., GhaniA.C.Mortality and progression to AIDS after starting highly active antiretroviral therapy. ATHENA Cohort Study Group.AIDS2003; 17: 2227–2236.
