title: Perceptions about the acceptability of assessments of HIV medication adherence in Lilongwe, Malawi and Chennai, India.
abstract: Little research exists on acceptability issues related to assessments of adherence to ART in resource-poor settings. To help prepare for two large-scale, multisite ART intervention trials, this qualitative study of individuals in Chennai, India (49 men, 11 women; 33 taking ART, 27 not) and Lilongwe, Malawi (5 men, 5 women, all taking ART) examined potential limitations of different types of adherence assessments: an adherence questionnaire, a pill diary, a pillbox, an electronic pill cap, and a medication punch card. Many participants reported that the various assessments would be acceptable. Potential limitations included issues surrounding literacy, the desire to appease one's medical provider, privacy and stigma, and "cheating." These potential limitations are similar to the limitations of these assessments in Western settings. However, the data highlight the need to consider individual patient level concerns when assessing ART adherence in different cultural settings. Innovative ways of monitoring adherence while maintaining standardization across sites are required in multisite trials.
authors.affiliation: Fenway Community Health, Research and Evaluation Department, Boston, Massachusetts 02215, USA. ssafren@fenwayhealth.org
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
authors.forename: N
authors.initials: N
authors.lastname: Kumarasamy
authors.forename: Mina
authors.initials: M
authors.lastname: Hosseinipour
authors.forename: Meaghan M
authors.initials: MM
authors.lastname: Harwood
authors.forename: Irving
authors.initials: I
authors.lastname: Hoffman
authors.forename: Marybeth
authors.initials: M
authors.lastname: McCauley
authors.forename: Allan
authors.initials: A
authors.lastname: Jumbe
authors.forename: Christina
authors.initials: C
authors.lastname: Nyirenda
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.forename: Suniti
authors.initials: S
authors.lastname: Solomon
authors.forename: David
authors.initials: D
authors.lastname: Celentano
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D002391:Catchment Area, Health; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents