Saturday, July 13, 2024

Study Reveals Discrepancies in Medication Adherence Measurement for HIV/AIDS Patients

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In the realm of HIV/AIDS treatment, ensuring accurate medication adherence is paramount. A recent study delves into the comparative effectiveness of self-report (SR) and indirect measurement tools in assessing adherence among antiretroviral therapy (ART) patients. This investigation not only highlights significant differences between these methods but also underscores the influence of various factors such as the year of reporting and geographic region on adherence results.

Research Methodology and Scope

The study systematically reviewed literature up to November 22, 2023, by searching databases such as PubMed, Embase, and the Cochrane Library. Researchers included studies that reported adherence to ART using both SR and indirect measurement methods, analyzing individual and group adherence separately. Discrepancies were statistically assessed through the Mann-Whitney U test or Wilcoxon signed-rank test, and correlations were evaluated using the Pearson correlation coefficient. A meta-epidemiological one-step analysis and network meta-analysis techniques were applied to compare various adherence assessment tools.

Key Findings and Statistical Analysis

The comprehensive analysis involved 65 original studies with 13,667 HIV/AIDS patients, leading to 112 comparisons between SR and indirect measurement tools. Significant differences were noted between individual and group adherence results (P < 0.05), with Pearson correlation coefficients of 0.843 and 0.684 respectively. SR-measured adherence was found to be 3.94% higher for individual adherence and 16.14% higher for group adherence compared to indirect methods. The study also identified that the year of reporting and geographic regions influenced these discrepancies.

Market access implications are evident, as varying adherence measurements can affect the availability and approval of ART medications in different regions. Accurate adherence data is crucial for regulatory bodies when making decisions about market entry and pricing of ART drugs. The observed overestimation in SR methods could lead to misguided policies if not properly accounted for.

Concrete and Valuable Inferences

Inferences from the Study

  • Self-report methods tend to overestimate adherence, influencing perceived effectiveness of ART.
  • Geographic and temporal variations suggest the need for region-specific adherence strategies.
  • Market access decisions should consider the discrepancies between SR and indirect measurements to ensure fair drug pricing and availability.
  • Integration of SR and indirect methods might provide a more accurate adherence picture, aiding in better policy formulation.

The study underscores the complexity in accurately measuring medication adherence among ART patients. The significant variability observed across studies indicates that self-report methods often overestimate adherence. Factors like year of reporting, geographic region, and the measurement tools used play critical roles in these discrepancies. Future research should aim at developing integrated adherence measurements combining SR data with indirect measures to gain a more comprehensive understanding of adherence behaviors.

Original Article:

Infect Dis Poverty. 2024 Jul 5;13(1):51. doi: 10.1186/s40249-024-01221-4.

ABSTRACT

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BACKGROUND: Given the critical importance of medication adherence in HIV/AIDS treatment, this study aims to compare medication adherence measured by self-report (SR) and indirect measurement among antiretroviral therapy (ART) patients, exploring the differences of adherence results measured by different tools.

METHODS: We systematically searched PubMed, Embase, and the Cochrane Library to identify all relevant literature published up to November 22, 2023, without language restrictions, reporting adherence to ART measured by both SR and indirect measurement methods, while also analyzing individual and group adherence separately. Discrepancies between SR and indirect measurement results were assessed using the Mann-Whitney U test or Wilcoxon signed-rank test, with correlations evaluated using the Pearson correlation coefficient. Following one-to-one comparisons, meta-epidemiological one-step analysis was conducted, and network meta-analysis techniques were applied to compare results obtained through specific adherence assessment tools reported in the identified articles.

RESULTS: The analysis encompassed 65 original studies involving 13,667 HIV/AIDS patients, leading to 112 one-to-one comparisons between SR and indirect measurement tools. Statistically significant differences were observed between SR and indirect measurement tools regarding both individual and group adherence (P < 0.05), with Pearson correlation coefficients of 0.843 for individual adherence and 0.684 for group adherence. During meta-epidemiological one-step analysis, SR-measured adherence was determined to be 3.94% (95% CI: -4.48-13.44%) higher for individual adherence and 16.14% (95% CI: 0.81-18.84%) higher for group adherence compared to indirectly measured results. Subgroup analysis indicated that factors such as the year of reporting and geographic region appeared to influence the discrepancies between SR and indirect measurements. Furthermore, network meta-analysis revealed that for both individual and group adherence, the results obtained from most SR and indirect measurement tools were higher than those from electronic monitoring devices, with some demonstrating statistical significance (P < 0.05).

CONCLUSIONS: The findings underscored the complexity of accurately measuring medication adherence among ART patients. Significant variability was observed across studies, with self-report methods showing a significant tendency towards overestimation. Year of reporting, geographic region, and adherence measurement tools appeared to influence the differences between SR and indirect measurements. Future research should focus on developing and validating integrated adherence measurements that can combine SR data with indirect measures to achieve a more comprehensive understanding of adherence behaviors.

PMID:38970140 | DOI:10.1186/s40249-024-01221-4

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