title: Measuring Patient Adherence to Malaria Treatment: A Comparison of Results from Self-Report and a Customised Electronic Monitoring Device.
abstract: BACKGROUND
  Self-report is the most common and feasible method for assessing patient adherence to medication, but can be prone to recall bias and social desirability bias. Most studies assessing adherence to artemisinin-based combination therapies (ACTs) have relied on self-report. In this study, we use a novel customised electronic monitoring device--termed smart blister packs--to examine the validity of self-reported adherence to artemether-lumefantrine (AL) in southern Tanzania.
  
  
  METHODS
  Smart blister packs were designed to look identical to locally available AL blister packs and to record the date and time each tablet was removed from packaging. Patients obtaining AL at randomly selected health facilities and drug stores were followed up at home three days later and interviewed about each dose of AL taken. Blister packs were requested for pill count and extraction of smart blister pack data.
  
  
  RESULTS
  Data on adherence from both self-report verified by pill count and smart blister packs were available for 696 of 1,204 patients. There was no difference between methods in the proportion of patients assessed to have completed treatment (64% and 67%, respectively). However, the percentage taking the correct number of pills for each dose at the correct times (timely completion) was higher by self-report than smart blister packs (37% vs. 24%; p<0.0001). By smart blister packs, 64% of patients completing treatment did not take the correct number of pills per dose or did not take each dose at the correct time interval.
  
  
  CONCLUSIONS
  Smart blister packs resulted in lower estimates of timely completion of AL and may be less prone to recall and social desirability bias. They may be useful when data on patterns of adherence are desirable to evaluate treatment outcomes. Improved methods of collecting self-reported data are needed to minimise bias and maximise comparability between studies.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Katia
authors.initials: K
authors.lastname: Bruxvoort
authors.affiliation: Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Charles
authors.initials: C
authors.lastname: Festo
authors.affiliation: Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cairns
authors.affiliation: Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Admirabilis
authors.initials: A
authors.lastname: Kalolella
authors.affiliation: Impact Evaluation Thematic Group, Ifakara Health Institute, Dar es Salaam, Tanzania.
authors.forename: Frank
authors.initials: F
authors.lastname: Mayaya
authors.affiliation: Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, United States of America.
authors.forename: S Patrick
authors.initials: SP
authors.lastname: Kachur
authors.affiliation: Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Schellenberg
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom.
authors.forename: Catherine
authors.initials: C
authors.lastname: Goodman
mesh_terms: D037621:Artemisinins / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007783:Lactones / Q000008:administration & dosage*; D016778:Malaria, Falciparum / Q000188:drug therapy*; D008297:Male; D055118:Medication Adherence; D008991:Monitoring, Physiologic / Q000295:instrumentation* / Q000379:methods*; D013636:Tanzania
chemical_list: D037621:Artemisinins; D007783:Lactones; C075875:artemisin