title: Adherence to antiretroviral therapy in HIV-positive adolescents in Uganda assessed by multiple methods: a prospective cohort study.
abstract: BACKGROUND
  The effectiveness of traditional adherence measurements used in adolescent populations is difficult to assess. Antiretroviral (ARV) adherence research among adolescents living with HIV in resource-constrained countries is particularly challenging and little evidence is available.
  
  
  OBJECTIVE
  The primary objective of this study was to determine the feasibility of a large-scale, long-term study using electronic adherence monitoring in Uganda. The secondary objective was to compare accuracy of pill count (PC) and self-report (SR) adherence with electronic medication vials (eCAPs™).
  
  
  METHODS
  Adolescents receiving ARV therapy at the Joint Clinical Research Centre in Kampala, Uganda, were recruited. ARVs were dispensed in eCAPs™ for 1 year. Person-pill-days (PPDs) [1 day where adherence was measured for one medication in one patient] were calculated and a weighted paired t-test was used to compare the levels of adherence among subjects for three different adherence measurement methods.
  
  
  RESULTS
  Fifteen patients were included: 40% were female, mean age was 14 years, mean baseline CD4+ cell count was 244 cells/μL, and average treatment duration was 9 months at study entry. Overall, 4721 PPDs were observed. Some eCAPs™ required replacement during the study resulting in some data loss. Consent rate was high (94%) but was slow due to age limit cut-points. Overall adherence for SR was 99%, PC was 97% and eCAP™ was 88% (p<0.05 for all comparisons). 93%, 67% and 23% of patients had an adherence of greater than 95% as measured by SR, PC and eCAP™ methods, respectively.
  
  
  CONCLUSIONS
  A large-scale adherence study in Uganda would be feasible using a more robust electronic monitoring system. Adherence measurements produced by PCs and self-reporting methods appear to overestimate adherence measured electronically.
authors: School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. mowiens@interchange.ubc.ca
authors: Matthew O
authors: MO
authors: Wiens
authors: Stuart
authors: S
authors: MacLeod
authors: Victor
authors: V
authors: Musiime
authors: Mark
authors: M
authors: Ssenyonga
authors: Ruth
authors: R
authors: Kizza
authors: Sabrina
authors: S
authors: Bakeera-Kitaka
authors: Richard
authors: R
authors: Odoi-Adome
authors: Francis
authors: F
authors: Ssali
mesh_terms: D000293:Adolescent; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D002648:Child; D055615:Electrical Equipment and Supplies; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D011446:Prospective Studies; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents