Differences between Self-Reported and Electronically Monitored Adherence among Patients Receiving Antiretroviral Therapy in Kenya

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Journal Article

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Author(s):
Thirumurthy, Harsha
Siripong, Nalyn
Vreeman, Rachel C.
Popeleches, Cristian
Habyarimana, James P.
Sidle, John E.
Siika, Abraham M.
Bangsberg, David R.

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Year Published:
Forthcoming

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AIDS

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DOI:
10.1097/QAD.0b013e328359aa68

PMCID:
PMC Journal - In Process

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Reference ID:
5461

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Abstract:

Background: Measurement of adherence to antiretroviral therapy (ART) by patient self-report is common in resource-limited settings but widely believed to overstate actual adherence. The extent to which these measures overstate adherence has not been examined among a large patient population., Methods: HIV-infected adult patients in Kenya who initiated ART within the past three months were followed for six months. Adherence was measured by participants' self-reports of doses missed in the past 7 days during monthly clinic visits and by continuous medication event monitoring system (MEMS) in participants' pill bottles. Seven-day self-reported adherence was compared to 7-day MEMS adherence, 30-day MEMS adherence, and adherence >90% during each of the first six months., Results: Self-reported and MEMS adherence measures were linked for 669 participants. Mean 7-day self-reported adherence was 98.7% and mean 7-day MEMS adherence was 86.0%, a difference of 12.7% (p < 0.01). The difference between the two adherence measures increased over time due to a decline in 7-day MEMS adherence. However, patients with lower MEMS adherence were in fact more likely to self-report missed doses and the difference between self-reported and MEMS adherence was similar for each number of self-reported missed doses. When analysis was limited to patients who reported rarely or never removing multiple doses at the same time, mean differences were 10.5% (p < 0.01)., Conclusions: There is a sizable and significant difference between self-reported and MEMS adherence. However, a strong relationship between the measures suggests that self-reported adherence is informative for clinical monitoring and program evaluation., (C) 2012 Lippincott Williams & Wilkins, Inc.

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http://dx.doi.org/10.1097/QAD.0b013e328359aa68

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Thirumurthy, Harsha; Siripong, Nalyn; Vreeman, Rachel C.; Popeleches, Cristian; Habyarimana, James P.; Sidle, John E.; Siika, Abraham M.; & Bangsberg, David R. (Forthcoming). Differences between Self-Reported and Electronically Monitored Adherence among Patients Receiving Antiretroviral Therapy in Kenya. AIDS. PMCID: PMC Journal - In Process