Do questionnaires, pill counts, or gadgets tell health staff if people with HIV are taking their drugs?

Health staff sometimes use questionnaires, counting pills, pharmacy notes, or gadgets to estimate if people with HIV are taking their antiretroviral drugs. None of these approaches were reliable when compared to viral load testing, according to the authors of a new Cochrane review.

People with HIV need to take antiretroviral drugs every day to keep the infection at bay. Viral load measurement in the blood is the most accurate test to determine treatment response to ART for HIV. However, it is not often available in low-resource settings. For this reason, providers might try to use alternative methods that are easy and simple to administer to find out whether patients are taking their drugs. 

The review author team, led by authors from South Africa and the UK, looked at 51 studies taking place between 2003 and 2021 on children and adults with HIV. The team estimated the diagnostic accuracy of different measures of adherence to ART treatment in people living with HIV.These included different measures of adherence, such asquestionnaires or rating scales filled out by patients, counting of patients’ pills, pharmacy notes, or electronic monitoring devices. 
Different studies showed very different results. These differences could not be explained by whether the studies included children or adults, whether they were conducted in richer or poor areas, or what cut-off they used to say if the viral load was high. The review authors noted that, based on the review’s findings, it is not clear whether these simple measures of adherence to ART treatment can be used to correctly identify people living with HIV at risk of poor viral response (viral non-suppression).  

Overall, in resource-limited settings, there is no single alternative adherence approach that may be an alternative for frequent viral load measurement.Senior author Dr Paul Hine said: “This shows how important it is to ensure that people have access to viral load testing as widely as possible.”  
Smith R, Villanueva G, Probyn K, Sguassero Y, Ford N, Orrell C, Cohen K, Chaplin M, Leeflang MMG, Hine P. Accuracy of measures for antiretroviral adherence in people living with HIV. Cochrane Database of Systematic Reviews 2022, Issue 7. Art. No.: CD015017. DOI: /10.1002/14651858.CD013080.pub2 

The editorial base of the Cochrane Infectious Diseases Group is funded by UK aid from the UK government for the benefit of low- and middle-income countries (project number 300342-104). The views expressed do not necessarily reflect the UK government’s official policies. 

This news article was first published on the LSTM website.