title: The adherence-outcome relationship is not altered by diary-driven adjustments of microelectronic monitor data.
abstract: OBJECTIVE
  The purpose of this study was to determine whether diary-driven adjustment of Medication Event Monitoring System (MEMS) data based on Supporting Information strengthens the relationship between measured antiretroviral medication adherence and plasma HIV viral load (VL).
  
  
  METHODS
  HIV+ adolescents on antiretroviral treatment were monitored with MEMS for 30 days preceding a VL measurement. The primary outcome was VL ≥ 400 copies/mL. Handwritten diaries were used to comprehensively record deviations from recommended use (bottle opened but dose not taken or bottle not opened and dose taken). Data were adjusted ("cleaned") based on diary events. Data were "capped" at the prescribed number of doses/day. Receiver operator characteristic analysis compared the relationships between (i) raw MEMS data, (ii) diary-cleaned, (iii) capped, or (iv) cleaned and capped MEMS data and VL.
  
  
  RESULTS
  Over 30 days preceding VL measurements, 273 adolescents had 465 diary events. Capping resulted in fewer patients classified as 95% adherent (65.2%) compared with raw data (71.4%), p < 0.001. Adherence was highly associated with VL (OR 1.05, p < 0.001). The area under the receiver operating characteristic curve for continuous adherence compared with VL was 0.89 (95%CI: 0.82-0.95). Neither diary-cleaning, capping, nor cleaning and capping MEMS data significantly altered the association between adherence and VL (p = 0.14, 0.40, and 0.19, respectively).
  
  
  CONCLUSIONS
  Medication Event Monitoring System data-cleaning based on diary entries did not affect the adherence-VL relationship.
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Eby
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Chapman
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Tafireyi
authors.initials: T
authors.lastname: Marukutira
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.|Department of Pediatrics, Section of Retrovirology, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Anabwani
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Ontibile
authors.initials: O
authors.lastname: Tshume
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Omphile
authors.initials: O
authors.lastname: Lepodisi
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Tebo
authors.initials: T
authors.lastname: Dipotso
authors.affiliation: Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.
authors.forename: Keboletse
authors.initials: K
authors.lastname: Mokete
authors.affiliation: Perelman School of Medicine, Departments of Medicine and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Gross
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Perelman School of Medicine, Departments of Pediatrics and Epidemiology, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lowenthal
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D001902:Botswana; D002648:Child; D004334:Drug Administration Schedule; D016903:Drug Monitoring; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008499:Medical Records; D010349:Patient Compliance; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; MEMS, self-report; adherence; electronic monitoring; pharmacoepidemiology