Monitoring medication adherence by unannounced pill counts conducted by telephone: reliability and criterion-related validity.
BACKGROUND
Although demonstrated valid for monitoring medication adherence, unannounced pill counts conducted in patients' homes are costly and logistically challenging. Telephone-based unannounced pill counts offer a promising adaptation that resolves most of the limitations of home-based pill counting.


OBJECTIVE
We tested the reliability and criterion-related validity of a telephone-based unannounced pill count assessment of antiretroviral adherence.


METHODS
HIV-positive men and women (N = 89) in Atlanta, Georgia, completed a telephone-based unannounced pill count and provided contemporaneous blood specimens to obtain viral loads; 68 participants also received an immediate second pill count conducted during an unannounced home visit.


RESULTS
A high degree of concordance was observed between the number of pills counted on the telephone and in the home (intraclass correlation [ICC] = .981, p < .001) and percent of pills taken (ICC = .987, p < .001). Adherence obtained by the telephone count and home count reached 92% agreement (Kappa coefficient = .94). Adherence determined by telephone-based pill counts also corresponded with patient viral load, providing evidence for criterion-related validity.


CONCLUSIONS
Unannounced telephone-based pill counts offer a feasible objective method for monitoring medication adherence.
Kalichman
Seth C
SC
Department of Psychology, University of Connecticut, Storrs, Connecticut 06269, USA. seth.k@uconn.edu
Amaral
Christina M
CM
Cherry
Chauncey
C
Flanagan
Jody
J
Pope
Howard
H
Eaton
Lisa
L
Kalichman
Moira O
MO
Cain
Demetria
D
Detorio
Mervi
M
Caliendo
Angela
A
Schinazi
Raymond F
RF
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D019538:Health Care Surveys / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D019562:Viral Load; D016903:Drug Monitoring
D019380:Anti-HIV Agents