A RECENT study presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco has unveiled a simplified approach to assessing antiretroviral therapy (ART) adherence among pregnant women living with HIV in Malawi. The research suggests that a single-question self-efficacy measure can effectively predict viral load suppression, potentially streamlining adherence assessments in resource-limited settings.
The study evaluated the ASES-Chichewa, a 10-item adherence self-efficacy scale adapted for Malawian populations from the original HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). Researchers administered this scale to 1,470 pregnant women living with HIV at Bwaila Hospital in Lilongwe between 2015 and 2019, with 399 participants enrolled in a three-year follow-up study. The primary objective was to assess the scale’s ability to estimate ART adherence and subsequent viral load suppression.
Initial findings indicated no significant difference in viral load suppression between participants with perfect (100%) and imperfect (<100%) self-efficacy scores on the full 10-item ASES-Chichewa. Specifically, 79% of participants with perfect self-efficacy achieved viral load suppression by the six-month follow-up, compared to 81% with imperfect self-efficacy (p = 0.6). However, a principal components analysis identified one particular item, ASES-Chichewa-1, as a major contributor to variance in self-efficacy scores. This item asked: "How confident are you that you can continue with your treatment (ART) even when your daily routine is disrupted?" When researchers used responses to this single question to define self-efficacy levels, significant differences emerged. Notably, 82% of participants with perfect self-efficacy on ASES-Chichewa-1 achieved viral load suppression by six months, compared to only 52% with imperfect self-efficacy (p = 0.02). These results suggest that the single-item measure, ASES-Chichewa-1, may serve as an effective screener for identifying individuals at risk of poor ART adherence and viral load suppression. Implementing such a streamlined assessment tool could enhance early identification of patients needing additional support, thereby improving health outcomes and reducing vertical transmission rates. Further research is warranted to validate the efficacy of ASES-Chichewa-1 as a prospective screening tool. Targeted interventions to bolster ART self-efficacy and adherence remain critical components in the global effort to manage HIV effectively and prevent mother-to-child transmission. Reference: Sheu L et al. Evaluating and Revising an Adapted Scale for Antiretroviral Therapy (ART) Adherence Self-Efficacy. Abstract 2301. The Conference on Retroviruses and Opportunistic Infections (CROI), San Francisco, CA, USA, March 9-12, 2025. Anaya Malik | AMJ
