Cited by 1,428HIV/AIDS Research and InterventionsMedication Adherence and ComplianceHIV/AIDS drug development and treatment

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Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments

Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., Wu, A. W., PATIENT CARE COMMITTEE & ADHERENCE·2000·AIDS Care

DOI 10.1080/09540120050042891

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Abstract

This paper describes the AACTG Adherence Instruments, which are comprised of two self-report questionnaires for use in clinical trials conducted by the Adult AIDS Clinical Trials Group (AACTG). The questionnaires were administered to 75 patients at ten AACTG sites in the USA. All patients were taking combination antiretroviral therapy (ART), including at least one protease inhibitor. Eleven per cent of patients reported missing at least one dose the day before the interview, and 17% reported missing at least one dose during the two days prior. The most common reasons for missing medications included 'simply forgot' (66%) and a number of factors often associated with improved health, including being busy (53%), away from home (57%) and changes in routine (51%). Less adherent patients reported lower adherence self-efficacy (p = 0.006) and were less sure of the link between non-adherence and the development of drug resistance (p = 0.009). They were also more likely to consume alcohol, to be employed outside the home for pay and to have enrolled in clinical trials to gain access to drugs (all p < 0.05). Twenty-two per cent of patients taking drugs requiring special instructions were unaware of these instructions. Each questionnaire took approximately ten minutes to complete. Responses to the questionnaires were favourable. These questionnaires have been included in six AACTG clinical trials to date and have been widely disseminated to investigators both in the USA and abroad.

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ART adherence in resource poor settings in sub-Saharan Africa: a multidisciplinary review
Wekesa, E. (2017) · Cited by 13
Adaptación del "Cuestionario de Evaluación de la Adhesión al Tratamiento antirretroviral" (CEAT-VIH) para su uso en Perú
Valderrama, E. T., Ortiz, C., Alfaro, C. O., García‐Jiménez, E., & Faus, M. J. (2008) · Institutional Repository of the University of Granada (University of Granada) · doi:10.30827/ars.v49i3.4967 · Cited by 13
Alexithymia, Assertiveness and Psychosocial Functioning in HIV: Implications for Medication Adherence and Disease Severity
McIntosh, R. C., Ironson, G. H., Antoni, M. H., FLETCHER, M. A., & Schneiderman, N. (2015) · AIDS and Behavior · doi:10.1007/s10461-015-1126-7 · Cited by 13
“Prescribed medications and adherence were assessed through an interviewer-administered AIDS Clinical Trials Group (ACTG) Adherence Measure [82].”
BackgroundMethod
Investigating the potentially important role of psychological flexibility in adherence to antiretroviral therapy in people living with HIV
Harrison, A., Scott, W., Timmins, L., Graham, C. D., & Harrison, A. M. (2021) · AIDS Care · doi:10.1080/09540121.2020.1771263 · Cited by 12
“Using an adherence measure validated in PLWHIV with established cut-offs and a specific timeframe may help (e.g., (Chesney et al., 2000).”
Method
HIV-specific unsupportive social interactions, health, and ethnicity in men living with HIV
Fekete, E. M., Deichert, N. T., & Williams, S. L. (2013) · Journal of Social and Personal Relationships · doi:10.1177/0265407513506796 · Cited by 12
“The General Health Behaviors measure developed by the Adult AIDS Clinical Trials Group (AACTG) was used as a guide in creating this measure (Chesney et al., 2000).”
Method
Levels of health literacy among people living with HIV in outpatient care: a cross-sectional study from Denmark
Rodkjær, L. Ø., Storgaard, M., Sørensen, N. T., & Schougaard, L. M. V. (2023) · AIDS Research and Therapy · doi:10.1186/s12981-023-00562-8 · Cited by 12
“Adherence was assessed by asking about missed doses over the preceding four days: “During the past four days, on how many days have you missed taking all your doses?” with the following response categories: “none”, “one day”, “two days”, “three days”, “four days” [18].”
Method
Opportunities for sexual transmission of antiretroviral drug resistance among HIV-infected patients in care
Soeters, H. M., Napravnik, S., Zakharova, O. I., Eron, J. J., & Hurt, C. B. (2013) · AIDS · doi:10.1097/01.aids.0000433240.78739.30 · Cited by 12
“Unautho records, UCHCC participants were offered the opportunity to complete a comprehensive, standardized, face-to-face interview, the Clinical, Sociodemographic and Behavioral Survey (CSDS), which incorporates multiple validated instruments, including 4-day adherence recall [36] and alcohol and substance use assessm…”
Method
Which Clinician Questions Elicit Accurate Disclosure of Antiretroviral Non-adherence When Talking to Patients?
Callon, W. A., Saha, S., Korthuis, P. T., Wilson, I. B., Moore, R. D., Cohn, J. A., & Beach, M. C. (2015) · AIDS and Behavior · doi:10.1007/s10461-015-1231-7 · Cited by 12
Clinical and Economic Implications of Non-Adherence to HAART in HIV Infection
Scalera, A., Bayoumi, A. M., OH, P. I., Risebrough, N. A., Shear, N. H., & Tseng, A. L.-I. (2002) · Disease Management & Health Outcomes · doi:10.2165/00115677-200210020-00003 · Cited by 12
Cognitive and behavioural correlates of non-adherence to HIV anti-retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology
Begley, K., McLaws, M., Ross, M. W., & Gold, J. (2008) · Clinical Psychologist · doi:10.1080/13284200802069043 · Cited by 12
“, 2002), conviction about connection between non-adherence and resistance (Chesney et al., 2000), treatment motivation (Duong et al.”
BackgroundMethodInfluential
Characteristics associated with virologic failure in high-risk HIV-positive participants with prior failure: a post hoc analysis of ACTG 5251
Robbins, G. K., Cohn, S. E., Harrison, L. J., Smeaton, L. M., Moran, L. E., Rusin, D., Dehlinger, M., Flynn, T., Lammert, S. M., Wu, A. W., et al. (2016) · HIV Clinical Trials · doi:10.1080/15284336.2016.1189754 · Cited by 12
Self-citation
Identifying the Intersection of Alcohol, Adherence and Sex in HIV Positive Men on ART Treatment in India Using an Adapted Timeline Followback Procedure
Schensul, J. J., Ha, T., Schensul, S. L., Sarna, A., & BRYANT, K. J. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1916-1 · Cited by 12
“From the Baseline survey three self-reported adherence measures were used: an Adult AIDS Clinical Trials Group (AACTG) 4-days recall adherence instrument [57], and a single question asking about number of days of missed doses in past 7 days.”
Method
Maternal Motivation to Take Preventive Therapy in Antepartum and Postpartum Among HIV-Positive Pregnant Women in South Africa: A Choice Experiment
Kim, H., Dowdy, D. W., Martinson, N. A., Kerrigan, D. L., Tudor, C., Golub, J. E., Bridges, J. F. P., & Hanrahan, C. F. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2324-x · Cited by 12
Tailoring Cognitive Behavioral Therapy for Trauma-Exposed Persons Living With HIV
López, C. M., Hahn, C. K., Gilmore, A. K., & Danielson, C. K. (2019) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2019.02.006 · Cited by 12
“The AIDS Clinical Trial Group (ACTG) Adherence Questionnaire (Chesney et al., 2000; Reynolds et al., 2007) is a validated adherence instrument with varying recall periods for past 4 days, past 3 days, past 2 days, past week, or past month.”
Method
Coverage and adherence of antiretroviral therapy among Chinese HIV‐positive men who have sex with men with high CD4 counts in the era of ‘Treat all’
Yang, X., Wang, Z. J., Harrison, S. E., & Lau, J. T. F. (2019) · Tropical Medicine & International Health · doi:10.1111/tmi.13353 · Cited by 12
Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain
Cunningham, C. O., Starrels, J. L., Zhang, C., Bachhuber, M. A., Sohler, N., LEVIN, F. R., Minami, H., Slawek, D. E., & Arnsten, J. H. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-043400 · Cited by 12
Magnitude of optimal adherence and predictors for a low level of adherence among HIV/AIDS-infected adults in South Gondar zone, Northwest Ethiopia: a multifacility cross-sectional study
Zewude, S. B., & Ajebe, T. M. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-056009 · Cited by 12
Depression and Its Relationship to Work Status and Income among HIV Clients in Uganda
Wagner, G. J., Ghosh‐Dastidar, B., Akena, D. H., Nakasujja, N., Okello, E. S., Luyirika, E. B. K., & Musisi, S. (2012) · World Journal of AIDS · doi:10.4236/wja.2012.23018 · Cited by 12
“adapted from the ACTG assessment battery [25], “I can count on my family and friends to give me the support I need”, and a 4-point rating scale from 1 “strongly dis-”
Gender differences in adherence to treatment and illness behavior in HIV/AIDS patients: an exploratory study in Spain
Ballester, R., García, S., Reinoso, I., & Campos, A. (2002) · Redalyc (Universidad Autónoma del Estado de México) · Cited by 12
Quality of life and HIV adherence self-efficacy in adolescents and young adults living with perinatal HIV in Chiang Mai, Thailand
Aurpibul, L., Detsakunathiwatchara, C., Khampun, R., Wongnum, N., Chotecharoentanan, T., & Sudjaritruk, T. (2022) · AIDS Care · doi:10.1080/09540121.2022.2075537 · Cited by 11
“The role of adherence self-efficacy in treatment adherence has been documented in previous studies (Chesney et al., 2000).”
Result
Protocol for a Controlled Experiment to Identify the Causal Role of Acute Alcohol Consumption in Condomless Sex among HIV-Positive MSM: Study Procedures, Ethical Considerations, and Implications for HIV Prevention
Shuper, P. A., Joharchi, N., & Rehm, J. T. (2015) · AIDS and Behavior · doi:10.1007/s10461-015-1128-5 · Cited by 11
“Two validated scales are employed to assess adherence, which include (1) a visual analogue scale (VAS) to identify the percentage of ART doses taken over the past month [64], and (2) an ACTGbased assessment that queries the number of doses of each ART medication missed over the past 4 days [65].”
Linear and Quadratic Associations of Plasma Oxytocin With Depressive Symptoms in Ethnic Minority Women Living With HIV
Seay, J., Lattie, E. G., Schneiderman, N., Antoni, M. H., Fekete, E. M., Mendez, A. J., Szeto, A., & FLETCHER, M. A. (2014) · Journal of Applied Biobehavioral Research · doi:10.1111/jabr.12016 · Cited by 13
Examining the interplay between depression, motivation, and antiretroviral therapy adherence: a social cognitive approach
Tatum, A. K., & Houston, E. (2016) · AIDS Care · doi:10.1080/09540121.2016.1220481 · Cited by 11
“Self-reported adherence was assessed with the AIDS Clinical Trials Group adherence questionnaire (Chesney et al., 2000).”
Method
Effects of individual and neighborhood socioeconomic status on antiretroviral therapy adherence: The role of adherence self-efficacy
Jiang, Y., Li, X., Cho, H., Brown, M. J., Qiao, S., & Haider, M. R. (2019) · Journal of Health Psychology · doi:10.1177/1359105319869809 · Cited by 11
“ART adherence was measured using three items adapted from the Adult AIDS Clinical Trials Group adherence instrument (Chesney et al., 2000), with a focus on recent adherence to reduce recall bias.”
Method
Examining the association between stress and antiretroviral therapy adherence among women living with HIV in Toronto, Ontario
Benoit, A. C., Burchell, A. N., O’Brien, K. K., Raboud, J., Gardner, S. L., Light, L., Beaver, K., Cotnam, J., Conway, T., Price, C. E., et al. (2020) · HIV Research & Clinical Practice · doi:10.1080/25787489.2020.1763711 · Cited by 9
Personality and adherence to antiretroviral therapy in HIV-infected adult patients
Hernández-Huerta, D., Parro-Torres, C., Madoz‐Gúrpide, A., Pérez-Elı́as, M. J., Moreno, S., & Mangado, E. O. (2021) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2021.110413 · Cited by 11
Quality of Life and Antiretroviral Therapy Adherence: A Cross-Sectional Study in Colombia
Narváez, M., Lins-Kusterer, L., Valdelamar-Jiménez, J. R., & Brites, C. R. (2022) · AIDS Research and Human Retroviruses · doi:10.1089/aid.2021.0233 · Cited by 11
“28 Adherence was calculated as the number of doses taken divided by the number of doses prescribed in the last 4 days.”
Measuring health literacy among people living with HIV who attend a community-based ambulatory clinic in Puerto Rico.
Rivero‐Méndez, M., Suárez-Pérez, E. L., & Solís-Báez, S. S. (2015) · PubMed · Cited by 11
Twelve-Year Mortality in HIV-Infected Patients Receiving Antiretroviral Therapy: The Role of Social Vulnerability. The ANRS CO8 APROCO-COPILOTE cohort
Protopopescu, C., Raff, F., Spire, B., Hardel, L., Michelet, C., Cheneau, C., Moing, V. L., Leport, C., Carrieri, P., & the ANRS CO8 APROCO-COPILOTE Study Group (2014) · Antiviral Therapy · doi:10.3851/imp2960 · Cited by 11
Health Status, Sexual and Drug Risk, and Psychosocial Factors Relevant to Postrelease Planning for HIV+ Prisoners
Feaster, D. J., Reznick, O. G., Zack, B., McCartney, K., Gregorich, S. E., & Brincks, A. M. (2013) · Journal of Correctional Health Care · doi:10.1177/1078345813499312 · Cited by 11
Antiretroviral therapy adherence in a sample of men with low socioeconomic status: The role of task-specific treatment self-efficacy
Houston, E., & Fominaya, A. W. (2014) · Psychology Health & Medicine · doi:10.1080/13548506.2014.986137 · Cited by 11
“Self-reported adherence was assessed with the AIDS Clinical Trials Group adherence questionnaire (Chesney et al., 2000).”
Method
A Comparison of Adherence Timeframes Using Missed Dose Items and Their Associations with Viral Load in Routine Clinical Care: Is Longer Better?
Crane, H. M., Nance, R. M., Delaney, J. A., Fredericksen, R. J., Church, A. E., Simoni, J. M., Harrington, R. D., Dhanireddy, S., Safren, S. A., McCaul, M. E., et al. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1566-8 · Cited by 11
“These more complex recall items such as sometimes used in the early ACTG studies [37] are more time-consuming and confusing and are thus of limited feasibility for wide-spread use in routine clinical care where regimens vary.”
Depression Among Alcohol Consuming, HIV Positive Men on ART Treatment in India
Ha, T., Schensul, S. L., Irving, M. L., Brault, M. A., Schensul, J. J., Prabhughate, P., & Vaz, M. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2339-3 · Cited by 11
The Costs of Silencing the Self and Divided Self in the Context of Physical Abuse, Racial/Ethnic Identity, and Medication Adherence in Women Living with HIV
Bruck-Segal, D., Schwartz, R. M., Cohen, M. H., Weber, K. M., Burke-Miller, J. K., Kassaye, S., & Brody, L. R. (2019) · Sex Roles · doi:10.1007/s11199-019-01086-0 · Cited by 12
Design of a randomized controlled trial of smoking cessation medications for alcohol reduction among HIV-positive heavy drinkers and daily smokers in St. Petersburg, Russia
Tindle, H. A., Freiberg, M. S., Gnatienko, N., Blokhina, E. A., Cheng, D. M., Yaroslavtseva, T. V., Bendiks, S., Winter, M. R., Krupitsky, E. M., & Samet, J. H. (2020) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2020.100625 · Cited by 11
An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition
Tanner, A. E., Dowshen, N., Philbin, M. M., Rulison, K. L., Camacho-González, A., Lee, S., Moore, S. J., Fortenberry, J. D., & Hussen, S. A. (2021) · JMIR Research Protocols · doi:10.2196/24565 · Cited by 12
Perceived Barriers to HIV Care and Viral Suppression Comparing Newly Diagnosed Women Living with HIV in Rural Uganda with and without a History of Intimate Partner Violence
Ogbonnaya, I. N., Reed, E., Wanyenze, R. K., Wagman, J. A., Silverman, J. G., & Kiene, S. M. (2021) · Journal of Interpersonal Violence · doi:10.1177/08862605211028284 · Cited by 11
Adhesión terapéutica : revisión histórica y estado de la cuestión en la infección por VIH/SIDA
Ballester, R. (2013) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.7.num.3.2002.3931 · Cited by 11
“(2000) Moatti et al. (2000) Olvido Hecht (1997) Chesney et al. (2000) Adhesión terapéutica en la infección por VIH/SIDA 165 tran el nivel educativo, las creencias culturales del paciente, la valoración de la gravedad de la enfermedad, la percepción acerca de la eficacia del tratamiento, la…”
Background
The Challenge of HIV for Feminist Theory
Rosengarten, M. (2004) · Feminist Theory · doi:10.1177/1464700104045409 · Cited by 11
“Yet taking pills is now well-documented within HIV social and psycho-social literature to be difficult for many and for a variety of reasons (Chesney et al., 2000; Race and Wakeford, 2000).”
Background
Social Networks of Substance Users With HIV Infection
Kelly, P. J., Ramaswamy, M., Li, X., Litwin, A. H., Berg, K. M., & Arnsten, J. H. (2011) · Western Journal of Nursing Research · doi:10.1177/0193945911419679 · Cited by 11
“This instrument was developed for use by the Adult AIDS Clinical Trials Group and has been widely used both domestically and internationally (Chesney et al., 2000).”
MethodResult
Food insecurity, HIV disease progression and access to care among HIV-infected Russians not on ART
Idrisov, B., Lunze, K., Cheng, D. M., Blokhina, E., Gnatienko, N., Patts, G. J., Bridden, C., Kleinman, R. E., Weiser, S. D., Krupitsky, E., et al. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1885-4 · Cited by 9
“The date of ART initiation was assessed at 6- and 12-month study visits among all study participants [32].”
Method

Authors: Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., Wu, A. W., & PATIENT CARE COMMITTEE & ADHERENCE
Affiliations: University of California, San Francisco (US)
Yale University (US)
University of California San Diego (US)
The Ohio State University (US)
Indiana University Indianapolis (US)
Johns Hopkins University (US)
ORCID: Chesney, M. A.
Ickovics, J. R.
Gifford, A. L.
Wu, A. W.
Venue: AIDS Care
Publisher: Informa UK Limited
Published: 2000-06
Volume: 12
Issue: 3
Pages: 255-266
ISSN: 0954-0121 (ISSN-L)
1360-0451
DOI: 10.1080/09540120050042891
OpenAlex: W2088423598
Cited by: 1,428
References: 12
Citations by year: 2026: 14 · 2025: 28 · 2024: 29 · 2023: 29 · 2022: 40 · 2021: 53 · 2020: 51 · 2019: 55 · 2018: 61 · 2017: 66 · 2016: 67 · 2015: 76 · 2014: 81 · 2013: 84 · 2012: 74
FWCI: 27.22
Type: journal article
Language: en
Open access: closed
Locations: AIDS Care (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (P50-MH42459, P30MH059037, P50MH042459, P30-MH 59037)
National Institute of Allergy and Infectious Diseases (U01AI-38858, U01AI038858)
Topics: Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords: antiretroviral therapy adherence, HIV, self-report questionnaire, medication non-adherence, adherence self-efficacy, alcohol consumption, protease inhibitors, clinical trial participants, questionnaire development
MeSH terms: Adult, Alcohol Drinking, Clinical Trials as Topic, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Patient Compliance, Pilot Projects, Surveys and Questionnaires, Risk Factors, Socioeconomic Factors, HIV Infections, Anti-HIV Agents, Substance-Related Disorders

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Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments

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