OBJECTIVES: To evaluate the rate of discordance between patients and physicians on adherence to highly active antiretroviral therapy
(HAART) and identify factors related to discordance in these two assessments.
DESIGN: Prospective, multicenter, cohort study (AdICONA) nested within the Italian Cohort Naïve Antiretrovirals (ICONA) study.
SETTING: Tertiary clinical centers.
PARTICIPANTS: The patients filled out a 16-item self-administered questionnaire on adherence to HAART. At the same time, physicians estimated
the current HAART adherence of their patient.
MAIN OUTCOME MEASURE: Discordance between patient and physician on adherence to antiretroviral therapy.
RESULTS: From May 1999 to March 2000, 320 paired patient-physician assessments were obtained. Patients had a mean plasma HIV RNA of
315 copies/ml (64% had undetectable HIV RNA) and a mean CD4+ cell count of 577 cells × 106/L. Nonadherence was reported by 30.9% of patients and estimated by physicians in 45.0% cases. In 111 cases (34.7%), patients
and physicians were discordant on adherence to HAART. Kappa statistics was 0.27. Using patient-assessed adherence as reference,
sensitivity, specificity, positive predictive value, and negative predictive value of physician-estimated adherence were 64.7%,
66.6%, 81.2%, and 45.8%, respectively. On multivariable analysis, low education level, unemployment, absence of a social worker
in the clinical center, and unavailability of afternoon visits were significantly correlated with patient-physician discordance
on adherence to antiretrovirals.
CONCLUSIONS: Physicians did not correctly estimate patient-reported adherence to HAART in more than one third of patients. Both social
variables and factors related to the clinical center were important predictors of discordance between patients and physicians.
Interventions to enhance adherence should include strategies addressed to improve patient-physician relationship.
Key words compliance - AIDS/HIV - doctor-patient relationship - quality of care - health care service
This research has been realized through the valuable contribution of all the AdlCoNA Study Group members: Aviano, Italy: U.
Tirelli, G. Nasti. Brescia, Italy: G. Carosi, C. Minardi. Cagliari, Italy: P.E. Manconi, P. Piano. Chieti, Italy: E. Pizzigallo,
J. Vecchiet. Firenze, Italy: F. Mazzotta, S. Lo Caputo. Latina, Italy: F. Soscia, L. Tacconi. Lucca, Italy: A. Scasso, A.
Vincenti. Mantova, Italy: A. Scalzini, G.C. Fibbia. Milano, Italy: M. Moroni, A. d’Arminio Monforte (Scientific Committee),
S. Melzi. Modena, Italy: R. Esposito, L. Cremonini. Napoli, Italy: M. Piazza, N. Abrescia, M.C. Izzo, M. De Marco, E. Manzillo,
S. Nappa. Piacenza, Italy: F. Alberici, M. Sisti. Perugia, Italy: S. Pauluzzi, K. Loso, P. Mele. Roma, Italy: A. Ammassari
(Scientific Committee), A. Antinori (Study Coordinator), G. Antonucci, M. Ciardi, S. Delia, P. De Longis, G. D’Offizi, G.
Ippolito (Scientific Committee), M. Lichtner, R. Murri (Scientific Committee), P. Narciso, P. Noto, N. Petrosillo, P. Pezzotti
(Scientific Committee), P. Rellecati, G. Rezza (Scientific Committee), P. Santopadre, M.P. Trotta (Scientific Committee),
V. Vullo, M. Zaccarelli. Torino: P. Caramello, G.C. Orofino. London, UK: A Cozzi-Lepri (Scientific Committee). Baltimore,
Md: A.W. Wu (Scientific Committee).
This study was funded by the Istituto Superiore di Sanità—II and III Programma Nazionale di Ricerca sull’AIDS and Ricerca
Corrente e Finalizzata degli IRCCS. The I.CO.N.A. network is supported by an educational grant from Glaxo-SmithKline, Italy.