title: Measuring adherence to antiretroviral therapy in northern Tanzania: feasibility and acceptability of the Medication Event Monitoring System.
abstract: BACKGROUND
  An often-used tool to measure adherence to antiretroviral therapy (ART) is the Medication Event Monitoring System (MEMS), an electronic pill-cap that registers date and time of pill-bottle openings. Despite its strengths, MEMS-data can be compromised by inaccurate use and acceptability problems due to its design. These barriers remain, however, to be investigated in resource-limited settings. We evaluated the feasibility and acceptability of using MEMS-caps to monitor adherence among HIV-infected patients attending a rural clinic in Tanzania's Kilimanjaro Region.
  
  
  METHODS
  Eligible patients were approached and asked to use the MEMS-caps for three consecutive months. Thereafter, qualitative, in-depth interviews about the use of MEMS were conducted with the patients. MEMS-data were used to corroborate the interview results.
  
  
  RESULTS
  Twenty-three of the 24 patients approached agreed to participate. Apart from MEMS-use on travel occasions, patients reported no barriers regarding MEMS-use. Unexpectedly, the MEMS-bottle design reduced the patients' fear for HIV-status disclosure. Patients indicated that having their behavior monitored motivated them to adhere better. MEMS-data showed that most patients had high levels of adherence and there were no bottle-openings that could not be accounted for by medication intake. Non-adherence in the days prior to clinic visits was common and due to the clinic dispensing too few pills.
  
  
  CONCLUSIONS
  MEMS-bottle use was readily accepted by patients. Although the MEMS-bottle was used accurately by most patients, patients need to be more explicitly instructed to continue MEMS-use when travelling. Even HIV-clinics with sufficient staff and free medication may impose structural adherence barriers by supplying an insufficient amount of pills.
authors.affiliation: Kilimanjaro Clinical Research Institute/Kilimanjaro Christian Medical Center PO Box 2236, Moshi, Tanzania. rlyimo7@yahoo.com
authors.forename: Ramsey A
authors.initials: RA
authors.lastname: Lyimo
authors.forename: Jossy
authors.initials: J
authors.lastname: van den Boogaard
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Msoka
authors.forename: Harm J
authors.initials: HJ
authors.lastname: Hospers
authors.forename: Andre
authors.initials: A
authors.lastname: van der Ven
authors.forename: Declare
authors.initials: D
authors.lastname: Mushi
authors.forename: Marijn
authors.initials: M
authors.lastname: de Bruin
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004349:Drug Packaging / Q000379:methods*; D004581:Electronics; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D013636:Tanzania
chemical_list: D044966:Anti-Retroviral Agents