Background: We compared the performance of self-reports, pill counts, and electronic adherence measures in monitoring antiretroviral therapy (ART) adherence and association with viral suppression among adolescents living with HIV (ALHIV). Setting: The study was conducted among 39 study clinics in the Greater Masaka region in Southern Uganda Methods: We used baseline data from 702 ALHIV aged 10 to 16 years receiving ART. Self-report was assessed using a three-item tool, pill counts were unannounced, while Wisepill captured device openings over 30 days. We determined the sensitivity, specificity, and area under the receiver-operator characteristic (ROC) curve for each adherence measure in discriminating ALHIV based on their viral suppression (<200 copies/mL) status. We also fit multilevel logistic regression models to determine the association between each adherence measure and viral suppression. Results: On average, 73% of ALHIV reported good (≥90%) ART Adherence, while 67.1% achieved viral suppression. We found disagreement between adherence measures with agreement coefficient ranging between 0.410 (self-report vs. Wisepill) and 0.545 for pill counts versus Wisepill. All three adherence measures had a low ability to predict viral suppression, with AUCs ranging between 0.560 for pill counts and 0.616 for self-reported adherence. Only self-reported adherence had a significant relationship with viral suppression, OR = 2.16 (95% CI: 1.25 – 3.81), p = 0.006. Conclusion: Substantial discrepancies exist across adherence measures. In this setting, low self-reported adherence can help in identifying adolescents at risk of virologic failure, although high self-reported adherence does not reliably exclude viremia.
Kizito et al. (Wed,) studied this question.