Detection of inadequate adherence prior to the development of drug resistance remains one of the most important and elusive goals for the treatment of HIV-infected patients in routine clinical care. The goal of this study is to test a brief, feasible, valid, and well-tolerated measure of computer-assisted self-administered interview (CASI) collected adherence to antiretroviral medications in routine clinical practice focusing on feasibility issues, optimal self-report strategy, and item selection. We will determine the impact of integrating routine adherence assessment and healthcare delivery team feedback with targeted care management into clinical care.
The specific aims are: 1. Integrate CASI adherence assessment into routine clinical care for all patients receiving HAART at the UW HIV clinic, a large multi-provider clinic. We will identify and address system-level, provider-level, and patient-level facilitators of and barriers to integrating CASI into clinical care. 2. Determine optimal strategies for identifying inadequate adherence in a routine clinical care setting. We will evaluate the validity of items with varying recall periods (4-, 7-, 14-, 30-, and 60-days) for number of missed doses, the 4-item Adult AIDS Clinical Trial Group assessment, a 30-day visual analogue scale item, and 30-day rating scale item in comparison with unannounced pill counts. We will examine analytic methods for self- reported adherence. In addition, we will determine the performance of adherence measures among individuals with depression and substance abuse disorders. 3. Examine the ability of self-reported adherence measurement to impact clinical outcomes with a 2x2 factorial design RCT. We will determine if healthcare delivery team notification of adherence, depression, and substance abuse scores along with tailored intervention recommendations and targeted care management leads to improvement in process and patient-level outcomes including adherence. Accurate assessment of adherence in routine clinical care is essential to target effective interventions and improve long-term clinical outcomes.

Public Health Relevance

to antiretroviral medication is the most important determinant of clinical outcomes including disease progression and death among HIV-infected patients receiving treatment. There is no widely-accepted approach to the assessment of adherence in clinical care settings. The goal of this study is to validate a novel method of adherence collection using touch-screen tablets for use in clinical care settings focusing on feasibility issues and optimal item selection. We will determine the impact of integrating routine adherence assessment and healthcare delivery team feedback with targeted care management into clinical care. Optimally and routinely assessing adherence in clinical settings is an important step toward maximizing the potential benefit of antiretroviral therapy for all patients.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Special Emphasis Panel (ZRG1-AARR-F (02))
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Stirratt, Michael J
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University of Washington
Internal Medicine/Medicine
Schools of Medicine
United States
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