{"doi":"10.1101/2022.05.11.22274977","title":"Adherence Monitoring Methods to Measure Virological Failure in People Living with HIV on Long-Term Antiretroviral Therapy in Uganda","abstract":"Abstract Appointment keeping and self-report within 7-day or and 30-days recall periods are non-objective measures of antiretroviral treatment (ART) adherence. We assessed incidence of virological failure (VF), predictive performance and associations of these adherence measures with VF among adults on long-term ART. Data for persons initiated on ART between April 2004 and April 2005, enrolled in a long-term ART cohort at 10-years on ART (baseline) and followed until December 2021 was analyzed. VF was defined as two consecutives viral loads ≥1000 copies/ml at least within 3-months after enhanced adherence counselling. We estimated VF incidence using Kaplan-Meier and Cox-proportional hazards regression for associations between each adherence measure (analyzed as time-dependent annual values) and VF. The predictive performance of appointment keeping and self-reporting for identifying VF was assessed using receiver operating characteristic curves and reported as area under the curve (AUC). We included 900 of 1,000 participants without VF at baseline: median age was 47 years (Interquartile range: 41-51), 60% were women and 88% were virally suppressed. ART adherence was ≥95% for all three adherence measures. Twenty-one VF cases were observed with an incidence rate of 4.37 per 1000 person-years and incidence risk of 2.4% (95% CI: 1.6%-3.7%) over the 5-years of follow-up. Only 30-day self-report measure was associated with lower risk of VF, adjusted hazard ratio (aHR)=0.14, 95% CI:0.05–0.37). Baseline CD4 count ≥200cells/ml was associated with lower VF for all adherence measures. The 30-day self-report measure demonstrated the highest predictive performance for VF (AUC=0.751) compared to appointment keeping (AUC=0.674), and 7-day self-report (AUC=0.687). The incidence of virological failure in this study cohort was low. Whilst 30-day self-report was predictive, appointment keeping and 7-day self-reported adherence measures had low predictive performance in identifying VF. Viral load monitoring remains the gold standard for adherence monitoring and confirming HIV treatment response.","journal":"medRxiv","year":2022,"id":308750,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9079,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":897333,"name":"Joseph Musaazi","orcid":"0000-0001-5245-4571","position":1,"is_corresponding":false},{"id":291580,"name":"Rachel King","orcid":"0000-0002-0085-3498","position":2,"is_corresponding":false},{"id":277333,"name":"Sheri A. Lippman","orcid":"0000-0003-3152-9372","position":3,"is_corresponding":false},{"id":291578,"name":"Andrew Kambugu","orcid":"0000-0002-3075-0211","position":4,"is_corresponding":false},{"id":291579,"name":"Andrew Mujugira","orcid":"0000-0001-6646-6733","position":5,"is_corresponding":false},{"id":892945,"name":"Jonathan Izudi","orcid":"0000-0001-9065-0389","position":6,"is_corresponding":false},{"id":335312,"name":"Rosalind Parkes‐Ratanshi","orcid":"0000-0001-9297-1311","position":7,"is_corresponding":false},{"id":335315,"name":"Agnes Kiragga","orcid":"0000-0002-0969-0699","position":8,"is_corresponding":false},{"id":291576,"name":"Barbara Castelnuovo","orcid":"0000-0001-7756-5032","position":9,"is_corresponding":false},{"id":291575,"name":"Stephen Okoboi","orcid":"0000-0002-8738-0397","position":0,"is_corresponding":true}],"reference_count":21,"raw_metadata":null,"created_at":"2026-07-19T00:33:07.132912Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}