JMIR Publications

ABSTRACT

Background:

Increasing HIV rates among young Latino sexual minority men (YLSMM) warrant innovative and rigorous studies to assess prevention and treatment strategies. Ecological momentary assessments (EMA) and electronic pill dispensers (EPD) have been used to measure antiretroviral therapy (ART) adherence repeatedly, in real-time, and in participants’ natural environments, but their psychometric properties among YLSMM are unknown.

Objective:

The study’s objective was to assess concurrent validity, acceptability, compliance, and behavioural reactivity of EMA and EPD among YLSMM with HIV.

Methods:

A convenience sample of 56 YLSMM with HIV with suboptimal ART adherence, ages 18-34 years, was recruited into a 28-consecutive-day EMA study. Concurrent validity was analysed by comparing median ART adherence rates and calculating Spearman correlations between ART adherence measured by EMA, EPD, and baseline retrospective validated three-item and single-item measures. Acceptability was assessed in exit interviews asking participants to rate EMA and EPD burden. Compliance was assessed by computing percent lost-to-follow-up, percent of EMAs missed, and percent of days the EPD was not opened that had corresponding EMA data self-reporting adherence to ARTs. Behavioural reactivity was assessed computing median change in ART adherence during the study period, using generalized mixed models to assess whether cumulative number of EMAs completed and days of EPD use predicted ART adherence over time, and by asking participants to rate perceived reactivity using a Likert scale.

Results:

EMA ART adherence was significantly correlated with baseline validated three-item (r=0.41, p-value .0025) and single-item (r=0.52, p-value <.0001) measures, but correlations were only significant for participants that reported EMA was not burdensome. Correlations for EPD ART adherence were weaker but significant (r=0.36, p-value .0091; r=0.34, p-value .0137, respectively). Acceptability was high for EMA (88.9%) and EPD (96.3%) per self-report. Loss-to-follow-up was 3.6% (2/56), with the remaining participants completing 88.6% (1,339/1,512) of study-prompted EMAs. The percentage of missed EMA surveys increased from 5.9% Week 1 of the study to 17.0% Week 4. Of 260 days when EPDs were not opened, 68.8% (179) had a corresponding EMA survey self-reporting ART adherence. Reactivity inferred from median change in ART adherence over time was 8.8% for EMA and -0.8% for EPD. Each completed EMA was associated with a 1.03 odds (95% confidence interval [CI] 1.00-1.07) of EMA ART adherence over time, and each day of EPD use with 0.97 odds (95% CI 0.96-0.99) of EPD ART adherence over time. Self-reported perceived behavioural reactivity was 38.9% for EMA and 35.2% for EPD.

Conclusions:

This study provides evidence of concurrent validity with retrospective validated measures for EMA- and EPD-measured ART adherence among YLSMM, when participant burden is carefully considered, without significant behavioural reactivity. While acceptability and compliance of EMA and EPD were high overall, noncompliance increased over time suggesting respondent fatigue.