Exploring Self-reported Adherence Measures to Screen for Elevated HIV Viral Load in Adolescents

A South African Cohort Study

Bibliographic Data

ID15338997
AuthorsSiyanai Zhou (0000-0002-6525-1244, University of Cape Town, corresponding author), Elona Toska (0000-0002-3800-3173, University of Cape Town), Nontokozo Langwenya (0000-0001-7883-621X, Oxford Policy Management), Olanrewaju Edun (0000-0002-0306-5171, Imperial College London), Lucie D Cluver (0000-0002-0418-835X, University of Cape Town), Lucia Knight (0000-0001-9938-6887, University of Cape Town)
Year2023
Volume27
Issue11
Pages3537-3547
Publication date2023-04-17
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueAIDS and Behavior (JOURNAL)
Journal identifiersISSN: 1090-7165 • E-ISSN: 1573-3254
PublisherSpringer Science+Business Media (PUBLISHER • DE)
DOI10.1007/s10461-023-04068-2
PMID37067612
OpenAlexW4366083523
LanguageEN
Citations received4
References cited42

The timely identification of ART non-adherence among adolescents living with HIV presents a significant challenge, particularly in resource-limited settings where virologic monitoring is suboptimal. Using South African adolescent cohort data (N = 933, mean age 13.6 ± 2.89 years, 55.1% female, follow-up = 2014-2018), we examined the association between elevated viral load (VL ≥ 1000 copies/mL) and seven self-reported adherence measures on missed doses, and clinic appointments -with varying recall timeframes. The best performing measures, which were significantly associated with elevated viral load in covariate-adjusted models are: any missed dose -past 3 days (sensitivity = 91.6% [95%CI: 90.3-92.8], positive predictive value (PPV) = 78.8% [95%CI: 77.2-80.4]), -past week (sensitivity = 87% [95%CI: 85.4-88.6], PPV = 78.2% [95%CI: 76.5-79.9]), -past month (sensitivity = 79.5% [95%CI: 77.5-81.4], PPV = 78.2% [95%CI: 76.4-79.9]), any past-month days missed (sensitivity = 86.7% [95%CI: 85.1-88.3], PPV = 77.9% [95%CI:76.2-79.6]), and any missed clinic appointment (sensitivity = 88.3% [95%CI: 86.8-89.8], PPV = 78.4% [95%CI: 76.8-79.9]). Combining the three best performing measures missed dose -past 3 days, -past week, and any past-year missed clinic appointment increased sensitivity to 96.4% while maintaining a PPV of about 78%. The discriminatory power of simple and easy-to-administer self-reported adherence measures in detecting elevated viral load warrants consideration in resource-limited settings and may contribute to the aims of the new Global Alliance to End AIDS in children and adolescents by 2030

Cohort · Human immunodeficiency virus (HIV · Viral load · HIV Research and Treatment · HIV/AIDS drug development and treatment · HIV/AIDS Research and Interventions · Medicine · Immunology · Internal Medicine

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