Instruments to assess adherence to medication in people living with HIV: a scoping review

Santos, André Pereira dos; Cordeiro, Jéssica Fernanda Corrêa; Fracarolli, Isabela Fernanda Larios; Gomide, Euripedes Barsanulfo Gonçalves; Andrade, Denise de

doi:10.11606/s1518-8787.2022056004475

Acessibilidade / Reportar erro

Brasil

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Sumário

Review • Rev. Saúde Pública 56 • 2022 • https://doi.org/10.11606/s1518-8787.2022056004475 copy

Instruments to assess adherence to medication in people living with HIV: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To compile the instruments validated in Brazil for assessing adherence of people living with HIV to antiretroviral therapy.

METHODS

Scoping review using the Web of Science, Scopus, Medline (via PubMed), Embase, BDENF, CINAHL and Lilacs databases. In addition, the Preprints bioRxiv, Google Scholar and OpenGrey servers were checked. There was no language restriction for the search, and it considered articles published from the year 1996 onwards.

RESULTS

Three publications were included in the qualitative synthesis. Following were the instruments identified “Questionário para Avaliação da Adesão ao Tratamento Antirretroviral” (Questionnaire for Assessment of Adherence to Antiretroviral Treatment) developed in Porto Alegre (RS) and published in 2007; the “Escala de autoeficácia para adesão ao tratamento antirretroviral em crianças e adolescentes com HIV/Aids” (Self-efficacy Scale for Adherence to Antiretroviral Treatment in Children and Adolescents with HIV/Aids) developed in São Paulo (SP) and published in 2008; and the “WebAd-Q, um instrumento de autorrelato para monitorar a adesão à terapia antirretroviral em serviços de HIV/Aids no Brasil” (WebAd-Q, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil) developed in São Bernardo do Campo (SP) and published in 2018. The instruments were validated in Brazil, and presented statistically acceptable values for psychometric qualities.

CONCLUSION

The instruments to assess adherence of people living with HIV to antiretroviral therapy are validated strategies for the Brazilian context. However, their (re)use in different settings and contexts of the nation should be expanded. The use of these instruments by health professionals can improve the understanding of factors that act negatively and positively on antiretroviral therapy adherence, and the proposition of strategies intended to consolidate good adherence and intervene in the treatment of people with low therapeutic engagement.

HIV Infections, therapy; Medication Adherence; Treatment Refusal; HIV Long-Term Survivors; Review

Database	Search Strategy
PubMed/Medline	(“Acquired Immunodeficiency Syndrome” OR HIV) AND (“medication adherence” OR compliance) AND (“Surveys and Questionnaires”)
CINAHL	(“Human Immunodeficiency Virus” OR “Anti-HIV Agents”) AND (“Medication Compliance”) AND (“Structured Questionnaires” OR “Surveys”)
Web of Science	(Acquired Immunodeficiency Syndrome OR HIV) AND (medication adherence OR compliance) AND (Surveys and Questionnaires)
Scopus	(“Acquired Immunodeficiency Syndrome” OR HIV) AND (“medication adherence” OR compliance) AND (“Surveys and Questionnaires”)
Embase	Acquired Immunodeficiency Syndrome AND medication compliance AND questionnaire
BVS (Lilacs, BDENF)	(Acquired Immunodeficiency Syndrome OR HIV) AND (medication adherence OR compliance) AND (Surveys and Questionnaires)
BVS (Lilacs, BDENF)	(Síndrome de inmunodeficiencia adquirida O VIH) Y (adherencia o cumplimiento a la medicación) Y (Encuestas y cuestionarios)
BioRxiv	“Acquired Immunodeficiency Syndrome AND medication adherence AND Surveys and Questionnaires”
Google Scholar	“Acquired Immunodeficiency Syndrome AND medication adherence AND Surveys and Questionnaires”
OpenGrey	“Acquired Immunodeficiency Syndrome AND medication adherence AND Surveys and Questionnaires”

Identification (author/year)	Objective	Method	Main results	Study limitations
Remor E, Milner-Moskovics J, Preussler G., 2007²⁸	Translate, adapt and validate the questionnaire for use in Brazil: Cuestionario para la Evaluación de la Adhesión al Tratamiento Antiretroviral (CEAT-VIH)”. It is a self-administered instrument to identify the degree of adherence to antiretroviral treatment in patients with HIV infection.	This methodological study was based on a questionnaire translated from the original Spanish into Portuguese, with a back translation process (Spanish/Portuguese/Spanish), and verbal evaluation of understanding with a small group of patients. The analysis of psychometric properties involved 59 patients on antiretroviral treatment from Porto Alegre, Rio Grande do Sul, Brazil. Internal consistency and external criterion-related validity, sensitivity and specificity supported validation. For the final version of the CEAT-VIH (20 questions), the total score is obtained by the sum of all items (minimum possible value 17, maximum possible value 89).	Adequate reliability of the questionnaire (α = 0.64) and validity related to an external criterion (viral load; r = -0.48; p < 0.001) were observed. Also, adequate sensitivity (79.2%) and specificity (57.1%) of the questionnaire were observed for detection between individuals with undetectable and detectable viral load. The optimal cutoff point suggested by the analysis is ≥ 76. The values below indicate insufficient adherence to treatment, and association with a detectable viral load. This score is associated with a sensitivity of 79.2%, and specificity of 57.1%.	1) Calculation for sample size is not presented. 2) Study in only one institution, making generalization difficult; therefore, it is not a nationally representative study. 3) The established cutoff point should be used with caution as the questionnaire is a self-administered instrument. 4) Hawthorne’s effect.
Costa LS, Latorre M do RD de O, Silva MH da, Bertolini DV, Machado DM, Pimentel SR, et al., 2008²⁹	Validate a self-efficacy scale for adherence to antiretroviral treatment in children and adolescents with HIV/Aids, taking into account the perspective of parents/guardians, and evaluate its reproducibility.	Methodological study conducted at the Hospital-Dia do Centro de Referência e Treinamento em DST/Aids (Day Hospital of the STD/Aids Reference and Training Center) in São Paulo. We interviewed the parents/guardians of 54 children and adolescents of 6 months to 20 years of age who went through routine consultation at the service. The self-efficacy data of adherence to antiretroviral prescription was calculated in two ways: factor analysis, and pre-defined formula. The internal consistency of the scale was verified by Cronbach’s α coefficient. Validity was assessed by comparing the mean scores between groups of patients adherent and non-adherent to antiretroviral treatment (Mann-Whitney test), and calculation of Spearman’s correlation coefficient between scores and clinical parameters. Reproducibility was verified using the Wilcoxon test, the intraclass correlation coefficient, and Bland-Altman plots.	The self-efficacy scale consists of 21 questions. It showed good internal consistency (α = 0.87), and good reproducibility (ICC = 0.69 and ICC = 0.75). As for validity, the self-efficacy scale for following antiretroviral prescription was able to discriminate patients with adherence and with insufficient adherence to antiretroviral treatment (p = 0.002), and showed significant correlation with CD4 count (r = 0.28; p = 0.04). Results are added with the fact that children/adolescents with adherence to antiretroviral treatment have higher expectancies of self-efficacy than those with insufficient adherence. The self-efficacy scale for following antiretroviral prescription can be used to assess adherence to antiretroviral therapy in children and adolescents with HIV/ Aids, taking into account the perspective of parents/caregivers.	This is not a Nationally representative study. Parents/caregivers responded for the children/adolescents. The perception of the target population of the study was not considered. Hawthorne’s effect.
Vale FC, Santa-Helena ET de, Santos MA, Carvalho WM do ES, Menezes PR, Basso CR, et al., 2018³⁰	Present the development and validation of the WebAd-Q Questionnaire, a self-report instrument to monitor adherence to antiretroviral therapy in HIV/Aids services in Brazil.	Methodological study. The WebAd-Q is an electronic questionnaire that contains three questions about taking antiretroviral drugs in the last week. It was constructed based on interviews and focus groups with 38 patients. Validity was verified in a study with a sample of 90 patients older than 18 years, on antiretroviral therapy for at least three months. The following comparative adherence measures were used: electronic monitoring, pill count, and self-report interview. The WebAd-Q was completed on day 6 twice, at least 1 hour apart. The viral load of patients was obtained from service records. Agreement between WebAd-Q responses, associations and correlations with viral load and performance against other measures of adherence were analyzed.	Among guest patients, 74 (82.2%) responded to the WebAd-Q. No difficulties in answering the questionnaire were reported. The average response time was 5 min 47 sec. The set of the three WebAd-Q questions obtained 89.8% agreement, with a Kappa of 0.77 (95% CI 0.61-0.94). WebAd-Q insufficient adherence responses were associated with detectable viral load. Moderate correlations of viral load with insufficient adherence scale according to WebAd-Q were obtained. For all the three WebAd-Q questions, patients with responses of insufficient adherence were also noted as less adherent according to the other measures of adherence. The WebAd-Q met the main requirements for questionnaire validation, showed high participant comprehension and association with viral load, and obtained agreement and good performance compared to competing measures.	This is not a Nationally representative study. Sample loss may have reduced the statistical power of the study. Hawthorne’s effect.

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[1] Correspondence: André Pereira dos Santos Avenida dos Bandeirantes, 3.900 Campus Universitário 14040-902 Ribeirão Preto, SP, Brasil E-mail: andrepereira.educa@gmail.com