Moving Antiretroviral Adherence Assessments to the Modern Era: Correlations Among Three Novel Measures of Adherence

Abstract

There is no gold standard for estimating antiretroviral therapy (ART) adherence. Feasible, acceptable, and objective measures that are cost- and time-effective are needed. US adults (N\u2009=\u200993) on ART for\u2009≥\u20093 months, having access to a mobile phone and internet, and willing to mail in self-collected hair samples, were recruited into a pilot study of remote adherence data collection methods. We examined the correlation of self-reported adherence and three objective remotely collected adherence measures: text-messaged photographs of pharmacy refill dates for pharmacy-refill-based adherence, text-messaged photographs of pills for pill-count-based adherence, and assays of home-collected hair samples for pharmacologic-based adherence. All measures were positively correlated. The strongest correlation was between pill-count- and pharmacy-refill-based adherence (r\u2009=\u20090.68; p\u2009<\u20090.001), and the weakest correlation was between self-reported adherence and hair drug concentrations (r\u2009=\u20090.14, p\u2009=\u20090.34). The three measures provide objective adherence data, are easy to collect, and are viable candidates for future HIV treatment and prevention research.