Measuring Patient Adherence to Malaria Treatment: A Comparison of Results from Self-Report and a Customised Electronic Monitoring Device

Abstract

BackgroundSelf-report is the most common and feasible method for assessing patient adherence to medication, but can be prone to recall bias and social desirability bias. Most studies assessing adherence to artemisinin-based combination therapies (ACTs) have relied on self-report. In this study, we use a novel customised electronic monitoring device—termed smart blister packs—to examine the validity of self-reported adherence to artemether-lumefantrine (AL) in southern Tanzania.MethodsSmart blister packs were designed to look identical to locally available AL blister packs and to record the date and time each tablet was removed from packaging. Patients obtaining AL at randomly selected health facilities and drug stores were followed up at home three days later and interviewed about each dose of AL taken. Blister packs were requested for pill count and extraction of smart blister pack data.ResultsData on adherence from both self-report verified by pill count and smart blister packs were available for 696 of 1,204 patients. There was no difference between methods in the proportion of patients assessed to have completed treatment (64% and 67%, respectively). However, the percentage taking the correct number of pills for each dose at the correct times (timely completion) was higher by self-report than smart blister packs (37% vs. 24%; p<0.0001). By smart blister packs, 64% of patients completing treatment did not take the correct number of pills per dose or did not take each dose at the correct time interval.ConclusionSmart blister packs resulted in lower estimates of timely completion of AL and may be less prone to recall and social desirability bias. They may be useful when data on patterns of adherence are desirable to evaluate treatment outcomes. Improved methods of collecting self-reported data are needed to minimise bias and maximise comparability between studies.

Evaluation of Adherence Should Become an Integral Part of Assessment of Patients With Apparently Treatment-Resistant Hypertension

“…27,[34][35][36] On the other hand, the sensitivity of these methods is poor 35,[37][38][39][40] ; they are heavily dependent on patient behavior, 41,42 affected by social desirability and recall biases, [43][44][45][46][47] and fail to provide information about the timing of doses, which is an essential 48 Accordingly, they are poorly correlated with direct methods such as MEMS and drug dosage in body fluids. 35,37,42,44,45,47 In particular, in a sample of 47 patients with apparently resistant hypertension, poor adherence was grossly underestimated by the Morisky Medication Adherence Scale-8 (26%) compared with drug monitoring (51%). 47 Compared with the latter, the sensitivity of Morisky Medication Adherence Scale-8 was found to be 26%, specificity 75%, positive predictive value 50%, and negative predictive value 51%.…”

“…44,50 Witnessed drug intake combined with ambulatory BP measurement might appear as a gold standard but cannot give information about persistence. Its application requires a hospital environment and the involvement of dedicated, trained healthcare professionals.…”

Adherence, Awareness, Access, and Use of Standard Diagnosis and Treatment Guideline for Malaria Case Management among Healthcare Workers in Meatu, Tanzania

“…Studies on adherence to malaria diagnosis and treatment guidelines among healthcare workers (HCWs) in Tanzania are limited [12]; however, one study reported on adherence to artemisinin-based combination therapies (ACTs) that relied on self-report [13].…”

<p>Does Antiretroviral Therapy Packaging Matter? Perceptions and Preferences of Antiretroviral Therapy Packaging for People Living with HIV in Northern Tanzania</p>

“…Calendared blister packaging, which meets the aforementioned criteria, has been associated with improved chronic medication adherence and may serve to further support ART adherence. 12,26,27 In fact, several participants in this study suggested blister packaging as a welcome alternative to current ART packaging. Given the drastic reduction in the number of pills required for HIV treatment, there is an opportunity to not only assess the cost-effectiveness of innovative ART packaging but also evaluate the acceptability of such packaging among PLWH.…”