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Patient self-report as a marker of adherence to antiretroviral therapy.

Sir—Duong et al. [1] have shown that patient self-report, together with determination of plasma drug levels and biological markers, has positive value in the assessment of adherence to antiretroviral therapy and its relationship to the attainment of virologic response. We have also studied the usefulness of patient self-report for first-line measurement of adherence to treatment in a group of Chinese patients with HIV/AIDS. In acknowledgment of the importance of adherence to highly active antiretroviral therapy (HAART) for the attainment of its benefits, we commenced a drug-adherence counseling program at our clinic in 1997. In this program, nurse counselors see patients who receive anti-retroviral treatment at each clinic visit, often at an interval of 4–6 weeks. Patients are asked questions regarding their knowledge about their drug regimens, their drug-taking behaviors, and the barriers to adherence, and they also receive counselling. In addition, the patients' drug adherence is assessed via a self-report method. Patients are asked to recall and report the number of doses that they have missed since the most recent visit; this question is similar to that posed by Duong et al. [1] about long-term adherence (i.e., the proportion of drugs taken in the previous 4 weeks). We consider each drug in the regimen important for control of the virus; thus, 1 drug is counted as 1 dose. Drug adherence level (expressed as a percentage) is defined as follows: [(total doses of the drug that were actually taken between the 2 visits) / (total doses of the drug that should have been taken between the 2 visits)] ϫ 100%. Four levels of grading are assigned according to the adher