AFISE Adaptation of the CEAT-VIH questionnaire

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: alexadima@gmail.com; aschweitzer@baylor-romania.ro 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=