Systematic review of the psychometric properties of the questionnaire to evaluate the adherence to HIV therapy (CEAT-VIH).

BACKGROUND: Since the use of the questionnaire to evaluate adherence to HIV therapy (acronym CEAT-VIH) has increased in the last decade and translation into new language versions has been requested, summarizing information regarding the psychometric properties of the instrument may be useful for researchers and practitioners.
OBJECTIVE: The purpose of this work was to review the psychometric properties of the questionnaire CEAT-VIH, available from published studies and research reports. DATA SOURCES: Medline, PsycINFO, Google Scholar and Google; the searched period was from 2001 to 2012. STUDY SELECTION: Forty-eight research materials referring to the questionnaire CEAT-VIH were initially gathered from academic databases and direct contact with researchers, before being analyzed. From the initial pool of material compiled (i.e., abstracts, technical reports or database files, dissertations or complete articles), only 20 comprised original data. STUDY APPRAISAL AND SYNTHESIS
METHODS: The selected research material described a variety of information in terms of the psychometric properties of the questionnaire. The results from the primary studies were then summarized in tables for evaluation, description and comparison.
RESULTS: Thirteen out of 16 studies reported a Cronbach's alpha value of above 0.70, supporting the internal consistency reliability of the CEAT-VIH questionnaire. No floor or ceiling effects were observed. Hypothesized relationships between the CEAT-VIH score and adherence-related variables (e.g., viral load, CD4+, compliance evaluated by physician or pharmacist, complexity of treatment and pill numbers) were observed, indicating validity evidence. Thus, variables expected to act as psychological risk factors for low adherence (e.g., stress, depression and anxiety) or protector factor (e.g., social support) to good adherence were observed. The scores of the questionnaire were also related to quality of life outcomes. Moreover, patients that received adherence intervention showed increased CEAT-VIH adherence scores. Sensitivity and specificity to correctly identify adherent patients with undetectable viral load were also observed for three studies. LIMITATIONS: Although the data provided in the reports were heterogeneous, these were valuable and reported enough evidence of validity for the instrument. The selected studies represented 41.7 % of those initially identified, and only eight out of 20 documents were peer reviewed.
CONCLUSIONS: The CEAT-VIH has been used for a variety of individuals of different ages, sex, socioeconomic and educational backgrounds. It has been a reliable and valid tool in measuring adherence to HIV treatment among different samples, and has been used with a wide range of study populations and countries (i.e., Brazil, Chile, Colombia, Mexico, Panama, Peru, Portugal, Puerto Rico, Romania and Spain). Encouraging data reported here may allow the recommendation of the CEAT-VIH as a valuable measure to use in HIV adherence research, especially in countries where the questionnaire already has available psychometric evidence.