The CASE adherence index: A novel method for measuring adherence to antiretroviral therapy

S. B. Mannheimer, R. Mukherjee, L. R. Hirschhorn, J. Dougherty, S. A. Celano, D. Ciccarone, K. K. Graham, J. E. Mantell, L. M. Mundy, L. Eldred, Michael Botsko, R. Finkelstein

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


The Center for Adherence Support Evaluation (CASE) Adherence Index, a simple composite measure of self-reported antiretroviral therapy (ART) adherence, was compared to a standard three-day self-reported adherence measure among participants in a longitudinal, prospective cross-site evaluation of 12 adherence programs throughout the United States. The CASE Adherence Index, consisting of three unique adherence questions developed for the cross-site study, along with a three-day adherence self-report were administered by interviews every three months over a one-year period. Data from the three cross-site adherence questions (individually and in combination) were compared to three -day self-report data and HIV RNA and CD4 outcomes in cross-sectional analyses. The CASE Adherence Index correlated strongly with the three-day self-reported adherence data (p <0.001) and was more strongly associated with HIV outcomes, including a 1-log decline in HIV RNA level (maximum OR=2.34; p <0.05), HIV RNA <400 copies/ml (maximum OR=2.33; p <0.05) and performed as well as the three-day self-report when predicting CD4 count status. Participants with a CASE Index score >10 achieved a 98 cell mean increase in CD4 count over 12 months, compared to a 41 cell increase for those with scores ≥10 (p <0.05). The CASE Adherence Index is an easy to administer instrument that provides an alternative method for assessing ART adherence in clinical settings.

Original languageEnglish (US)
Pages (from-to)853-861
Number of pages9
JournalAIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV
Issue number7
StatePublished - Oct 1 2006

ASJC Scopus subject areas

  • Social Psychology
  • Health(social science)
  • Public Health, Environmental and Occupational Health


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