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This study aims to evaluate the accuracy of self-reported antiretroviral adherence compared to dried blood spot measurements in HIV-infected pregnant women.

May 25, 2026Open Access

Self-report and dry blood spot measurement of antiretroviral medications as markers of adherence in pregnant women in rural South Africa

Key Points

This study aims to evaluate the accuracy of self-reported antiretroviral adherence compared to dried blood spot measurements in HIV-infected pregnant women.
392 HIV-infected pregnant women completed self-report adherence measures (VAS and ACTG)
Dried blood spots were collected to detect antiretroviral medication levels
Agreement between self-reports and DBS was analyzed using Kappa statistics and ROC curve metrics
Self-reported adherence rates were 89% (VAS), 80% (ACTG), while DBS showed 74%
Poor agreement with DBS was found (VAS: Kappa = 0.101; ACTG: Kappa = 0.081)
Self-reported adherence was significantly overestimated compared to actual medication levels

Abstract

Antiretroviral (ARV) adherence is essential to prevent mother-to-child transmission of HIV. This study compared self-reported adherence versus ARV detection in dried blood spots (DBS) among N = 392 HIV-infected pregnantwomen in SouthAfrica (SA).Women completed two self-reported adherence measures visual analog scale (VAS), AIDS Clinical Trials Group Adherence (ACTG). Adherence was 89% (VAS), 80% (ACTG), and 74% (DBS). Self-report measuresmarginally agreed withDBS(VAS:Kappa = 0.101, Area under the ROC curve (AUROC) = 0.543; ACTG: Kappa = 0.081,AUROC = 0.538). Self-reported adherence was overestimated and agreement with DBS was poor. Validation of self-reportedARVadherence among pregnant HIV women in SA is needed.

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