Adherence to antiretroviral medication in Romanian adolescents:
Adaptation of the CEAT-VIH questionnaire
Abstract We report the translation and adaptation to Romanian of the CEAT-VIH, an internationally validated self-report measure of adherence to HIV
medication.
Introduction As a consequence of nosocomial infection in the late 1980’s, a relatively
large and geographically concentrated number of HIV infected adoles-
cents now live in Constanta, Romania. Th e Baylor Black Sea Founda-
tion off ers psychosocial support services for this unique population. Th e
transition to adulthood raises specifi c issues of adherence to medication due to the shift from a carer-managed adherence to self-management.
Th ese issues are particularly important for HIV treatment due to its low
tolerance to non-adherence. One barrier to researching adherence in
our settings is the lack of self-report measures of adherence validated on
Romanian populations.
Objectives As a fi rst step towards investigating adherence in our population, the
CEAT-VIH (“Cuestionario para la Evaluación de la Adhesión al Trata-
miento Antirretroviral en Personas con Infección por VIH Y Sida” in
original; Remor, 2002, 2008) has been translated and adapted to Roma-
nian. CEAT-VIH is an internationally validated instrument for the clinical
assessment of adherence (initially developed in Spain, validated in Brazil,
Portugal, Mexico, Columbia, Peru). It consists of 20 items addressing self-
reported behavioral indicators and determinants of adherence (Table 1). Example
(approximate
English
Content targeted
translation)
Indicators of adherence
- dose omission
Have you ever skipped taking pills?
- adhering to
Do you usually take your pills at the correct
medication schedule
time?
Determinants of adherence
How
well
do
you
feel
you
manage
taking
- self-effi cacy
pills?
- perceived barriers/
How
diffi
cult
it
is
for
you
to
take
pills?
diffi culties
- expectancies/
How much do you feel taking pills helps
perceived benefi ts
you?
Do
you
have
specifi
c
strategies
to
remember
- memory/recall
taking pills?
- doctor-patient
How would you rate your relationship with
relationship
your doctor?
How
much
do
you
think
you
know
about
- information
the treatment?
Table 1. CEAT-VIH item examples
Methods Th e adaptation procedures consisted in back-translation, examination of metric properties based on data collected from a random sample from
comparability and interpretability (Sperber, 2004), piloting on a
our target population (data analysis using R; R Development Core Team,
small sample from the target population and examination of psycho-
2009).
Results • Sample: 162 adolescents, 85 females, age range 18-24, mean treat-
ment duration 9 years (range 1-22 years), 80 from urban areas, 147 un-
employed (of which only 39 currently studying), 22 with children. See
Figure 1 for distribution of scores.
• Th e instrument showed acceptable reliability Cronbach’s α = .77 and
external validity (Table 2). Th ese values are comparable to prior versions
(e.g. for the Spanish version, Cronbach’s α = .73, correlation with viral
load = -.20 concurrently and -.24 after 6 months).
• CEAT-VIH scores were not related to gender, age, level of education
and duration of treatment.
.35 .34 .30
(.21 to .48 at 95% CI)
p<.001 (.16- .50 95% CI)
p<.001, N=111 (.01 to .54 at 95% CI)
p=.05, N=46
.19 Ns Ns
(.03 to.33 at 95% CI)
p=.02 N=49 N=22
Table 2. External validity analysis (depending on time intervals between measurements of diff erent indices)
Authors:
Alexandra Dima 1 , Ana-Maria Schweitzer 2 ,
Ruxandra Neculau 2 , Eduardo Remor 3 , Sebastian
Wanless 2
1
School of Health in Social Science, University of Edin-
burgh, UK
2
Baylor Black Sea Foundation, Constanta, Romania
3
Universidad Autónoma de Madrid, Spain
Contact:
[email protected];
[email protected]
50
55
60
65
CEA7í9,+VFRUH UDQJHí
*Note: Similar results were obtained using Kendall τ
Conclusion
(.06 to .45 at 95% CI)
p=.01, N=88
(.06 to .37 at 95% CI)
p=.01, N=150 XUEDQ
UXUal
Doctor’s
1= stop therapy
assessment 2= < 80%
3= 80-95%
4= > 95%
Viral load 0= >400 c/ml
1=