Long‐term utility of measuring adherence by self‐report compared with pharmacy record in a routine clinic setting

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Abstract
Objectives: To compare long‐term adherence to antiretroviral therapy in an HIV service, as measured by self‐report and by pharmacy records. To determine the level of adherence by each measure required to suppress viral load in a majority of patients.Methods: The percentage of prescribed doses taken was calculated from (a) the number of missed doses in the previous 28 days reported by patients in a questionnaire at each clinic visit, and (b) pharmacy dispensing records. These were compared with each other and with HIV viral load data.Results: Mean adherence was 96.2% by pharmacy record over 44 months and 98.6% by self‐report over 25 months. The two methods correlated with each other (P<0.001) and the proportion of patients with viral load P=0.001) and pharmacy record (P=0.004). Fewer than 60% of patients always had viral loads P<0.001). Adherence by both measures increased over time.Conclusions: Self‐reported antiretroviral adherence correlates with pharmacy dispensing records and predicts suppression of viral load at levels ≥97%. It is practical to adopt this into routine HIV clinical care.