Standard measures are inadequate to monitor pediatric adherence in a resource-limited setting.
This study aims to compare the use and cost of objective and subjective measures of adherence to pediatric antiretroviral treatment in a primary care facility in South Africa. In a 1-month longitudinal study of 53 caregiver-child dyads, pharmacy refill (PR), measurement of returned syrups (RS), caregiver self-report (3DR) and Visual Analogue Scale (VAS) were compared to Medication Event Monitoring System (MEMS). Adherence was 100% for both VAS and 3DR; by PR and RS 100% and 103%, respectively. MEMS showed that 92% of prescribed doses were administered, but only 66% of these within the correct 12-hourly interval. None of the four measures correlated significantly with MEMS. MEMS data suggest that timing of doses is often more deviant from prescribed than expected and should be better addressed when monitoring adherence. Of all, MEMS was by far the most expensive measure. Alternative, cheaper electronic devices need to be more accessible in resource-limited settings.
Universitätsmedizin, Georg-August University, Göttingen, Germany. alexdmueller@gmail.com
Alexandra D
AD
Müller
Heather B
HB
Jaspan
Landon
L
Myer
Ashley Lewis
AL
Hunter
Guy
G
Harling
Linda-Gail
LG
Bekker
Catherine
C
Orrell
D019380:Anti-HIV Agents / Q000592:standards / Q000627:therapeutic use*; D017028:Caregivers; D002648:Child; D002675:Child, Preschool; D016903:Drug Monitoring / Q000295:instrumentation* / Q000592:standards; D001330:Electronic Data Processing / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D018670:Monitoring, Ambulatory / Q000379:methods*; D010147:Pain Measurement; D010594:Pharmacies; D013019:South Africa; D011795:Surveys and Questionnaires; D019562:Viral Load
D019380:Anti-HIV Agents