Diary study of adherence to antiretroviral therapy in people living with HIV

Background. Current empirical understanding of adherence to antiretroviral therapy (ART) is limited and the majority of current research is cross-sectional. Diary methodology provides an opportunity to capture the fluctuating nature of variables influencing adherence, close to the time that they occur. A limited number of diary studies have been conducted with people living with HIV (PLHIV) and few have investigated patterns of treatment adherence and psychological variables simultaneously.
Aims. To investigate the day-to-day factors associated with adherence to ART in PLHIV. To investigate the feasibility of diary methodology used to investigate adherence to ART in PLHIV.
Method. A mixed methods design comprising 2 parts was used: a diary study, using multilevel diary methodology (study 1) and qualitative semi-structured interviews (study 2). Study 1: participants (n = 18) completed an initial questionnaire, and a 14-day diary, the diary recorded adherence to ART and day-to-day variables (such as mood and stressors).
Study 2: interviews were conducted with HIV service users (n = 4) and HIV healthcare staff (n = 5). The interviews explored factors influencing the general feasibility of diary methodology in HIV populations.
Results. Full adherence (100%) was reported in terms of taking tablets, however, there was variability in reported adherence in terms of taking medication at the correct time (‘adherence timing’). Anticipatory negative affect associated with non-adherence and attitude (positive) towards treatment regime were the only two daily variables (measured in the diary) associated with optimal adherence timing. The relationships between adherence timing and the daily variables were moderated by a number of variables, including: illness perceptions, perceived stigma and beliefs about medications.
The majority of participants who completed the diaries were male (88.9%) and white (72.2%), females and ethnic minority groups were under-represented. The interviews resulted in the identification of multiple barriers and facilitators of diary methodology in HIV populations. In particular, barriers to study uptake and completion were identified.
Conclusions. A number of variables were found to be associated with optimal adherence timing. However, conclusions are limited due to the small sample size and under- representation of certain groups in the HIV population. Diary methodology may be more feasible within certain subgroups of the HIV population. Future research and clinical implications have also been considered.