Assessment of Adherence to Antiviral Therapy in HIV-Infected Children Using the Medication Event Monitoring System, Pharmacy Refill, Provider Assessment, Caregiver Self-Report, and Appointment Keeping

Abstract

The authors sought to assess the utility of the electronic Medication Event Monitoring System (MEMS) in monitoring adherence to highly active antiretroviral therapy (HAART) in HIV-infected children and to compare this with other methods of adherence assessment. Twenty-six perinatally HIV-infected children being treated with three or more antiretroviral medications and their caregivers were enrolled and prospectively followed-up for 6 months. Adherence was assessed using MEMS monitoring of one antiretroviral, pharmacy refill records of all antiretrovirals, a caregiver self-report interview, a physician/nurse questionnaire, and appointment-keeping behavior. Viral loads measured at the end of the 6-month period were compared with the various adherence assessment methods. Adherence rates for the MEMS-monitored medication ranged from 12.7% to 97.9% (median = 81.4%), and 11 of the participants (42%) had less than 80% adherence using this method. A MEMS adherence rate greater than 80% was associated with viral load below the threshold of detection 6 months after enrollment (p <.001). Although not as robust, pharmacy refill rates for all antiretroviral medications were also associated with virologic response. The highest specificity was attained when both MEMS and pharmacy refill were used in combination. Physician assessment of adherence rate as well as appointment-keeping behavior was associated with virologic response, whereas caregiver self-report was not.

Electronically monitored adherence to medications by newly diagnosed patients with juvenile rheumatoid arthritis

“…The active joint count finding contradicts pediatric studies that reported greater disease activity to be associated with lower adherence to medications for HIV (18), renal disease (23), and seizures (24). However, these studies were cross-sectional, and it is possible that lower adherence produced increased disease activity.…”

“…A recent study of children with human immunodeficiency virus (HIV) (18) also supports the 80% cutoff score. In this study children with detectable viral loads (a measure of active disease) were Ͻ80% adherent to highly active antiretroviral therapy (18).…”

Adherence to Antiretroviral Therapy for Pediatric HIV Infection: A Qualitative Systematic Review With Recommendations for Research and Clinical Management

“…In the 3 studies that assessed adherence by clinic attendance, estimates varied almost linearly according to the assessment interval, with lower levels for longer intervals. For example, perfect clinic attendance was achieved by 21% of the patients in the previous 365 days, 33 65% in the previous 180 days, 34 and 88% of patients in the previous 90 days. 31,33 As seen in Table 1, the 3 studies that used therapeutic drug monitoring, the 2 that relied on medical chart review, and the 2 with EDM generally produced lower estimates of adherence than did studies using the other methods.…”

Pediatric Adherence to Antiretroviral Therapy in Resource-Poor Settings: Challenges and Future Perspectives

“…Self-reported/caregiver adherence tends to overestimate the prevalence of adherence due to social desirability or recall bias factors [27]. In this sense, Farley et al found self-report to be unreliable when compared with electronic measurement [28].…”