1999 Articles

An Observed Performance Test of Medication Management Ability in HIV: Relation to Neuropsychological Status and Medication Adherence Outcomes

Albert, Steven M; Weber, Christine M; Todak, George; Polanco, Carmen; McElhiney, Martin; Rabkin, Judith; Stern, Yaakov; Marder, Karen

Neuropsychological assessment may identify mild deficits in HIV-infected persons, but it is sometimes unclear if such deficits compromise functional competencies, such as the ability to adhere to complex medication regimens. We examined the relationship between neuropsychological status (NP), observed performance on a medication management test (MMT), and antiviral medication adherence as elicited in a 3-day recall measure. Two samples of HIV+ subjects (n = 20, n = 41) were used to develop and validate the MMT. An additional 57 HIV+ patients taking antivirals were assessed to examine NP, MMT, and adherence outcomes. NP performance was scored according to age- and education-based norms. Adherence was assessed by comparing reported medication use to medication insert information. Poorer performance on the MMT was associated with scores <−1 SD below norms in tests of memory (RAVLT), executive function (Odd Man Out), and psychomotor skill (Grooved Pegboard). Half the sample made >1 adherence error, as reported in the recall measure. Number of errors was related to both NP and MMT performance. Deficits identified in NP assessment and captured in an observed performance test of medication management are related to HIV medication adherence.