13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

MEASUREMENT OF ADHERENCE TO ANTIRETROVIRAL THERAPY (ART) IN PATIENTS RECEIVING FREE TREATMENT AT A GOVERNMENT HOSPITAL IN MALAWI

HIV Med 2007; 8(Suppl. 1):11 (abstract no. P6)

David J Bell², Yamika Kapitao², Rosemary Sikwese³, Joep van Oosterhout³ and David G Lalloo^1
1Liverpool School of Tropical Medicine, Liverpool, Merseyside, UK, ²MalawiLiverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, ³Dept of Medicine, College of Medicine, Blantyre, Malawi

AIMS: High levels of adherence to ART are critical for good treatment outcomes and preventing resistance. In Africa, adherence has generally been reported to be equal or superior to that in the West, but has usually been measured by pill counts (PC) or self report. We used MEMS (Medication Event Monitoring Systems) caps to assess adherence in Malawian adults taking twice daily Triomune, a generic fixed combination of stavudine, lamivudine and nevirapine.

METHODS: HIV-positive adults on Triomune were recruited from the ART clinic in a large public hospital. Over 1 month, we compared adherence by PC (the standard method at the clinic), self report with a short adherence questionnaire and MEMS caps, which recorded each pill bottle opening.

RESULTS: Data from 80 patients were available for analysis. The mean age was 38.6 years, 57.5% were female. Median time on ART was 13.2 (range: 3– 63) months. Using MEMS, the mean and median adherences were 88.1 and 97.5%. MEMS adherence was ≥95% for 46 (57.5%) and <80% for 13 (16.2%) patients. Adherence was higher in women than in men, 92.7% versus 81.9% (P=0.19). Mean and median adherences by PC were 98.6% and 100%, higher than those using MEMS (P<0.001). There was no clear correlation between PC and MEMS adherence. Self reports of missing tablets did not correlate with poor MEMS or PC adherence.

CONCLUSION: The study shows the complexities of measuring adherence in this setting and probable overestimation of adherence by PC and self report. The low MEMS adherence raises concerns about the development of drug resistance. Improved methods are needed to detect non-adherence in developing countries and validation of MEMS with drug levels and virological outcome is important.

2007-03-29
P6

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