title: The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings.
abstract: BACKGROUND
  Pill counts are often used to measure adherence to ART, but there is little data on how they affect adherence. We previously showed a bivariate relationship between clinicians counting pills and adherence in patients receiving HIV care in Kenya. We present a secondary analysis of the relationship between numbers of pill counts and clinical outcomes in resource limited settings.
  
  
  METHODS
  Patients initiating ART at Kijabe Hospital were monitored for the number of discretionary pill counts performed by their clinician in the first 6 months of ART. Subjects were followed for at least 1 year after enrollment. The number of clinician pill counts was correlated to ART adherence. The primary endpoints were time to treatment failure, defined as a detectable HIV-1 viral load, death; or loss to follow-up.
  
  
  RESULTS
  Clinician pill counts were done at 68% of clinic visits for 304 subjects. There was a positive correlation between the number of clinician pill counts and ART adherence (r = 0.21, p <0.001). Patients were divided into 3 groups (0 counts, 1 to 3 counts, 4 to 7 counts) and exhibited adherence of 76%, 84%, and 92%, respectively (p = 0.004). Time to treatment failure for these groups was 220 days, 438 days, and 497 days (P<0.01), respectively. Time to virologic failure in living patients remaining in the cohort was longer in those with more pill count (P =0.02). Multi-variate analysis adjusting for co-variates affecting time to treatment failure found that that clinician pill counts were associated with a decreased risk of treatment failure (HR = 0.69, p =0.04).
  
  
  CONCLUSIONS
  The number of clinician pill count performed was independently associated with better adherence and a decreased risk of treatment failure. The use of clinician pill counts should be further studied as an adherence promoter through a randomized clinical trial.
authors: A.I.C. Kijabe Hospital, Kijabe, Kenya ; University of Nairobi, Nairobi, Kenya.
authors: Loice
authors: L
authors: Achieng
authors: Helen
authors: H
authors: Musangi
authors: Katherine
authors: K
authors: Billingsley
authors: Sharon
authors: S
authors: Onguit
authors: Edwin
authors: E
authors: Ombegoh
authors: LeeAnn
authors: L
authors: Bryant
authors: Jonathan
authors: J
authors: Mwiindi
authors: Nathaniel
authors: N
authors: Smith
authors: Philip
authors: P
authors: Keiser
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006295:Health Resources / Q000600:supply & distribution*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents