title: Adherence to antiretroviral therapy in patients receiving free treatment from a government hospital in Blantyre, Malawi.
abstract: OBJECTIVE
  To compare 3 measures of adherence to antiretroviral therapy (ART) in HIV-positive adults receiving free treatment from a public hospital in Malawi.
  
  
  METHODS
  Adherence was measured over 1 month by pill count (PC), self-report, and a medication event monitoring system
  
  
  RESULTS
  Data from 80 patients were available for analysis. The mean patient age was 38.6 years, and 57.5% were female. The mean adherence using the MEMS cap (MC) was 88.1%. Forty-six (57.5%) patients had MC adherence > or =95%, and 13 (16.2%) had <80% adherence. There was no association between MC adherence and time on ART. Mean PC adherence was 98.6%, significantly higher than MC adherence (P < 0.001). There was no clear relation between PC and MC adherence: 4 patients had MC adherence <20% but PC adherence of 100%. Self-reports of missing a tablet did not correlate with poor MC adherence.
  
  
  CONCLUSIONS
  The study shows the complexities of measuring adherence and probable overestimation of adherence by PC and self-report. Because these are the main methods used in developing countries, this raises concerns about the development of drug resistance. Improved methods are needed to detect nonadherence in developing countries, and validation of MC data with drug levels and virologic outcome in this setting is important.
authors.affiliation: Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi. belldavidj@gmail.com
authors.forename: David J
authors.initials: DJ
authors.lastname: Bell
authors.forename: Yamika
authors.initials: Y
authors.lastname: Kapitao
authors.forename: Rosemary
authors.initials: R
authors.lastname: Sikwese
authors.forename: Joep J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.forename: David G
authors.initials: DG
authors.lastname: Lalloo
mesh_terms: D000284:Administration, Oral; D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016903:Drug Monitoring / Q000379:methods; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006773:Hospitals, Municipal; D006801:Humans; D008295:Malawi; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012646:Self Administration / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
chemical_list: D044966:Anti-Retroviral Agents