Adherence to antiretroviral medication in Romanian HIV patients: is it about taking or timing?

Abstract

Background: Antiretroviral treatment (ART) requires high adherence to achieve therapeutic benefits; patients need to administer all doses recommended per day (taking adherence) and do so at exact time intervals (timing adherence). These two elements have been previously measured through electronic monitoring (EM), which is less easily applicable to routine care. Developing a self-report questionnaire that targets taking and timing adherence would facilitate clinical assessment and intervention. Methods: We developed the ProMAS-Rom-HIV based on ProMAS, a Dutch tool validated with item response theory methodology. Items were back-translated to Romanian, adapted to ART, and piloted via cognitive interviewing. One hundred and four HIV patients (63% women, mean age 31 +-7%, 20% with detectable viral load) completed the 12-item test version. Results of most recent viral load tests were collected from medical files. We examined ProMAS-Rom-HIV via Mokken Scaling, and performed Wilcoxon rank sum tests with viral load. Findings: Eight items reflected two separate dimensions: timing and taking adherence (3 and 5 items), with good psychometric properties (e.g. H(se)=.74(.07) and .62(.08); omega=.87 and .75). They were weakly associated with each other (Spearman’s rho=.23). People with undetectable viral load were more likely to show high adherence for both timing (W=857, p=.01) and taking (W=777, p=.04). Discussion: Using the ProMAS-Rom-HIV in clinical practice opens up new intervention possibilities. Both behaviours can be now measured via self-report, and specific barriers for timing and taking adherence identified and targeted with more precise interventions. The tool would further benefit from validation against EM data and other clinical contexts.