Assessment of Adherence to HIV Protease Inhibitors: Comparison and Combination of Various Methods, Including MEMS (Electronic Monitoring), Patient and Nurse Report, and Therapeutic Drug Monitoring

Hugen, P.W.H.; Langebeek, Nienke; Burger, David M.; Zomer, B.; Leusen, Rob van; Schuurman, Rob; Koopmans, P.P.; Hekster, Y.A.

doi:10.1097/00126334-200207010-00009

Cited by 114 publications

(35 citation statements)

References 22 publications

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“…In our study, self-reported missed cART doses in a 7-day recall period varied widely across CCASAnet sites, ranging from 1.6% in Mexico to 33.0% in Honduras. Although there are several methods for measuring adherence, and self-reported measures may overestimate the use of medication compared to microelectronic devices(7,36), our study shows an association between self-reported missed cART doses and a lower probability of viral suppression. These findings further support the use of the RST as a reliable measure of adherence that may be incorporated into routine clinical care(19).…”

Section: Discussionmentioning

confidence: 61%

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

et al. 2016

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This cross-sectional study describes substance use prevalence and its association with cART adherence among 3343 individuals receiving care at HIV clinics in Argentina, Brazil, Chile, Honduras, Mexico, and Peru. A rapid screening tool evaluated self-reported 7-day recall of alcohol, marijuana, cocaine, heroin, and methamphetamine use, and missed cART doses. Overall, 29.3% individuals reported having ≥ 1 alcoholic drinks, 5.0% reported any illicit drug use and 17.0% reported missed cART doses. In the logistic regression model, compared to no substance use, alcohol use (adjusted odds ratio (AOR)=2.46, 95% confidence interval (CI): 1.99–3.05), illicit drug use (AOR=3.57, 95% CI: 2.02–6.30), and using both alcohol and illicit drugs (AOR=4.98, 95% CI: 3.19–7.79) were associated with missed cART doses. The associations between substance use and likelihood of missing cART doses point to the need of targeting alcohol and illicit drug use to improve adherence among people living with HIV in Latin America.

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Section: Discussionmentioning

confidence: 61%

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

et al. 2016

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“…Adherence measured electronically is consistently more closely associated with HIV-1 RNA than are other methods (48, 49). In research, EDMs have been the measurement method of choice (50, 51). Unfortunately, these technologies are currently impractical outside of studies because they may be burdensome to patients and incompatible with adherence-promoting strategies, such as pill cases.…”

Section: Guidelinesmentioning

confidence: 99%

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

Thompson¹,

Mugavero²,

Amico³

et al. 2012

Ann Intern Med

544

460

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Description After HIV diagnosis, timely entry into HIV medical care and retention in that care are essential to the provision of effective antiretroviral therapy (ART). ART adherence is among the key determinants of successful HIV treatment outcome and is essential to minimize the emergence of drug resistance. The International Association of Physicians in AIDS Care convened a panel to develop evidence-based recommendations to optimize entry into and retention in care and ART adherence for people with HIV. Methods A systematic literature search was conducted to produce an evidence base restricted to randomized, controlled trials and observational studies with comparators that had at least 1 measured biological or behavioral end point. A total of 325 studies met the criteria. Two reviewers independently extracted and coded data from each study using a standardized data extraction form. Panel members drafted recommendations based on the body of evidence for each method or intervention and then graded the overall quality of the body of evidence and the strength for each recommendation. Recommendations Recommendations are provided for monitoring of entry into and retention in care, interventions to improve entry and retention, and monitoring of and interventions to improve ART adherence. Recommendations cover ART strategies, adherence tools, education and counseling, and health system and service delivery interventions. In addition, they cover specific issues pertaining to pregnant women, incarcerated individuals, homeless and marginally housed individuals, and children and adolescents, as well as substance use and mental health disorders. Recommendations for future research in all areas are also provided.

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“…Adherence assessment by caregiver reports is commonly used in studies reporting ART among children and is consistently higher than adherence by other measures like pill count or pharmacy refill, suggesting that caregivers likely overestimate their child's adherence [12,13]. Electronic dose monitoring with technologies like Medication Event Monitoring Systems (MEMS ® ) – bottle caps fitted with a microchip that records the time and date of each bottle opening – is most consistently associated with virological outcomes [14,15] but is often too expensive for routine use in LMICs outside of research settings [16]. …”

Section: Introductionmentioning

confidence: 99%

Measuring adherence to antiretroviral therapy in children and adolescents in western Kenya

Vreeman

Nyandiko

Liu

et al. 2014

Journal of the International AIDS Society

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IntroductionHigh levels of adherence to antiretroviral therapy (ART) are central to HIV management. The objective of this study was to compare multiple measures of adherence and investigate factors associated with adherence among HIV-infected children in western Kenya.MethodsWe evaluated ART adherence prospectively for six months among HIV-infected children aged ≤14 years attending a large outpatient HIV clinic in Kenya. Adherence was reported using caregiver report, plasma drug concentrations and Medication Event Monitoring Systems (MEMS®). Kappa statistics were used to compare adherence estimates with MEMS®. Logistic regression analyses were performed to assess the association between child, caregiver and household characteristics with dichotomized adherence (MEMS® adherence ≥90% vs. <90%) and MEMS® treatment interruptions of ≥48 hours. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated.ResultsAmong 191 children, mean age at baseline was 8.2 years and 55% were female. Median adherence by MEMS® was 96.3% and improved over the course of follow-up (p<0.01), although 49.5% of children had at least one MEMS® treatment interruption of ≥48 hours. Adherence estimates were highest by caregiver report, and there was poor agreement between MEMS® and other adherence measures (Kappa statistics 0.04–0.37). In multivariable logistic regression, only caregiver-reported missed doses in the past 30 days (OR 1.25, 95% CI 1.14–1.39), late doses in the past seven days (OR 1.14, 95% CI 1.05–1.22) and caregiver-reported problems with getting the child to take ART (OR 1.10, 95% CI 1.01–1.20) were significantly associated with dichotomized MEMS® adherence. The caregivers reporting that ART made the child sick (OR 1.12, 95% CI 1.01–1.25) and reporting difficulties in the community that made giving ART more difficult (e.g. stigma) (OR 1.14, 95% CI 1.02–1.27) were significantly associated with MEMS® treatment interruptions in multivariable logistic regression.ConclusionsNon-adherence in the form of missed and late doses, treatment interruptions of more than 48 hours and sub-therapeutic drug levels were common in this cohort. Adherence varied significantly by adherence measure, suggesting that additional validation of adherence measures is needed. Few factors were consistently associated with non-adherence or treatment interruptions.

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Assessment of Adherence to HIV Protease Inhibitors: Comparison and Combination of Various Methods, Including MEMS (Electronic Monitoring), Patient and Nurse Report, and Therapeutic Drug Monitoring

Cited by 114 publications

References 22 publications

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

Substance Use and Adherence Among People Living with HIV/AIDS Receiving cART in Latin America

Guidelines for Improving Entry Into and Retention in Care and Antiretroviral Adherence for Persons With HIV: Evidence-Based Recommendations From an International Association of Physicians in AIDS Care Panel

Measuring adherence to antiretroviral therapy in children and adolescents in western Kenya

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