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These data are representative of patients in usual clinical care and, so, it is likely that our results are generalisable to other high-income settings. Our analyses may be subject to a number of biases. We assumed that viral load measures should be done every 6 months: if a viral load measurement was not available within this time period, then we had to exclude the patient from analyses. Thus, patients included in analyses may have been more adherent to care than excluded patients. On the other hand, less adherent patients may have been monitored more closely and, therefore, be more likely to be included.

Questionnaires were not routinely administered at regular time intervals and, therefore, it was not feasible to derive a 1-year self-report adherence measure without heavily reducing the sample size or making strong assumptions about adherence in the time between questionnaires. Association of adherence levels with viral failure may be different for newer ART regimens which have longer half-lives.

Cohorts should consider carefully how best to collect and make use of adherence data for patient care within their healthcare setting. Pharmacy refill data require time and effort for their management, but provided a better tool, than self-report data, for predicting viral failure in our study. Harmonisation of pharmacy refill data management should be attempted in order to ensure that we are using the same tools.

Without this, we need to recognise that differences in dispensing will influence refill data. Refill data are not as useful as self-report data in facilitating immediate interventions to change behaviour, which may prevent patients from experiencing subsequent viral failure.


We thank all patients, doctors, cohort pharmacists and study nurses associated with the participating cohort studies. All authors contributed to study design, collection of data, data interpretation, writing the paper and approved the final version. National Center for Biotechnology Information , U. Journal List J Clin Med v. J Clin Med. Published online Oct 5. Suzanne M. Crane , 2 Tracy R. Glass , 3 Benita Yip , 4 Viviane D. Mugavero , 8 Jan P. Tate , 9 Jodie Guest , 10 Nicholas L. Turner , 1 Margaret T. May , 1 and Jonathan A. Sterne 1.

Find articles by Suzanne M. Heidi M. Tracy R. Find articles by Benita Yip. Viviane D. Find articles by Viviane D.

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Michael J. Jan P. Nicholas L. Find articles by Nicholas L. Margaret T. Find articles by Margaret T. Jonathan A. Find articles by Jonathan A. Author information Article notes Copyright and License information Disclaimer. Received Aug 14; Accepted Sep Associated Data Supplementary Materials jcms Abstract Adherence to antiretroviral therapy ART is critical for successful treatment of Human Immunodeficiency Virus HIV , but comparisons across settings are difficult because adherence is measured in different ways. Keywords: HIV, antiretroviral therapy, adherence, viral failure, cohort studies.

Introduction Adherence to antiretroviral therapy ART sufficient to suppress viral replication is critical for successful treatment of HIV [ 1 , 2 , 3 , 4 , 5 ]. Methods 2. Open in a separate window. Figure 1. Analysis Patients were only included in the analysis if they had data on both adherence and viral load. Results Adherence data were available on 11, patients: from the four cohorts with pharmacy data, and from the four cohorts with self-report data. Figure 2. Table 2 Viral suppression and levels of adherence across cohorts.

Figure 3. Receiver operating characteristic ROC curves for cohorts with pharmacy data. Figure 4. Sensitivity Analyses For cohorts with pharmacy data, there was weak evidence that age modified the effect of adherence on failure Web Table 1 , see Supplementary Materials. Discussion 4.

Main Results We combined data from eight HIV cohort studies: four with adherence measured using patient self-report and four using pharmacy refill data. Context Pharmacy refill and self-report are different tools for measuring adherence that have different characteristics and uses [ 20 ]. Strengths and Weaknesses We investigated how adherence to ART is measured across cohorts from two continents providing routine clinical care in high-income settings.

Implications Cohorts should consider carefully how best to collect and make use of adherence data for patient care within their healthcare setting. Acknowledgments We thank all patients, doctors, cohort pharmacists and study nurses associated with the participating cohort studies.

Click here for additional data file. Author Contributions S. References 1. Wood E. Lima V. Hogg R. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. Antinori A. Garcia de Olalla P. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected patients. Immune Defic.

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Paterson D. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Williams A. A proposal for quality standards for measuring medication adherence in research. AIDS Behav. Berg K. Practical and conceptual challenges in measuring antiretroviral adherence. Arnsten J. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: Comparison of self-report and electronic monitoring.

McMahon J. Pharmacy adherence measures to assess adherence to antiretroviral therapy: Review of the literature and implications for treatment monitoring. Grimes D. Measurement issues in using pharmacy records to calculate adherence to antiretroviral drugs. HIV Clin. Steiner J. The assessment of refill compliance using pharmacy records: Methods, validity, and applications.

May M. Cohort profile: Antiretroviral therapy cohort collaboration art-cc Int. Ammassari A.

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Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. Glass T. Longitudinal analysis of patterns and predictors of changes in self-reported adherence to antiretroviral therapy: Swiss HIV cohort study.

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Patterson S. Cohort profile: Haart observational medical evaluation and research homer cohort. StataCorp LP. Stata Statistical Software: Release Kim N. Measuring persistence to oral hypoglycemic agents in type 2 diabetic veterans. Refill adherence to oral hypoglycemic agents and glycemic control in veterans. Liu H. A comparison study of multiple measures of adherence to HIV protease inhibitors. Kitahata M.

Pharmacy-based assessment of adherence to haart predicts virologic and immunologic treatment response and clinical progression to aids and death. Townsend M. Association between pharmacy medication refill-based adherence rates and cd4 count and viral-load responses: A retrospective analysis in treatment-experienced adults with HIV. Cambiano V. Use of a prescription-based measure of antiretroviral therapy adherence to predict viral rebound in HIV-infected individuals with viral suppression. HIV Med.

Simoni J. Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management. Nieuwkerk P. Self-reported adherence to antiretroviral therapy for HIV-1 infection and virologic treatment response: A meta-analysis.

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Tommelein E. Accuracy of the medication adherence report scale mars-5 as a quantitative measure of adherence to inhalation medication in patients with copd. Van Steenis M. Editing the Complete Letters of Henry James. Talking about Money: Art and Commerce in America. Henry James and Globalization. Back Matter Pages About this book Introduction This book explores landmark criticism on a writer who continues to command critical attention.

In addition to mapping out the existing critical terrain, these essays offer a sense of future trajectories in James studies. Essays consider James' own criticism and theories of narrative and architecture, James' letters, money and globalization. America biography commerce consciousness editing essay future gender globalization Henry James history history of literature imagination oral discourse William James.

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