title: Electronic monitoring of treatment adherence and validation of alternative adherence measures in tuberculosis patients: a pilot study.
abstract: OBJECTIVE
  To assess adherence to community-based directly observed treatment (DOT) among Tanzanian tuberculosis patients using the Medication Event Monitoring System (MEMS) and to validate alternative adherence measures for resource-limited settings using MEMS as a gold standard.
  
  
  METHODS
  This was a longitudinal pilot study of 50 patients recruited consecutively from one rural hospital, one urban hospital and two urban health centres. Treatment adherence was monitored with MEMS and the validity of the following adherence measures was assessed: isoniazid urine test, urine colour test, Morisky scale, Brief Medication Questionnaire, adapted AIDS Clinical Trials Group (ACTG) adherence questionnaire, pill counts and medication refill visits.
  
  
  RESULTS
  The mean adherence rate in the study population was 96.3% (standard deviation, SD: 7.7). Adherence was less than 100% in 70% of the patients, less than 95% in 21% of them, and less than 80% in 2%. The ACTG adherence questionnaire and urine colour test had the highest sensitivities but lowest specificities. The Morisky scale and refill visits had the highest specificities but lowest sensitivities. Pill counts and refill visits combined, used in routine practice, yielded moderate sensitivity and specificity, but sensitivity improved when the ACTG adherence questionnaire was added.
  
  
  CONCLUSIONS
  Patients on community-based DOT showed good adherence in this study. The combination of pill counts, refill visits and the ACTG adherence questionnaire could be used to monitor adherence in settings where MEMS is not affordable. The findings with regard to adherence and to the validity of simple adherence measures should be confirmed in larger populations with wider variability in adherence rates.
authors: Radboud University Nijmegen Medical Centre, University Centre for Chronic Diseases Dekkerswald, Groesbeek, Netherlands. jossyvandenboogaard@gmail.com
authors: Jossy
authors: J
authors: van den Boogaard
authors: Ramsey A
authors: RA
authors: Lyimo
authors: Martin J
authors: MJ
authors: Boeree
authors: Gibson S
authors: GS
authors: Kibiki
authors: Rob E
authors: RE
authors: Aarnoutse
mesh_terms: D000328:Adult; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010865:Pilot Projects; D011795:Surveys and Questionnaires; D013636:Tanzania; D014376:Tuberculosis / Q000188:drug therapy*