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The 7th EAHSC Pharmacy refill counts and self-reported adherence overestimate adherence to antiretroviral treatment among people living with HIV in Kilimanjaro,

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Presentation on theme: "The 7th EAHSC Pharmacy refill counts and self-reported adherence overestimate adherence to antiretroviral treatment among people living with HIV in Kilimanjaro,"— Presentation transcript:

1 The 7th EAHSC Pharmacy refill counts and self-reported adherence overestimate adherence to antiretroviral treatment among people living with HIV in Kilimanjaro, Tanzania Marion Sumari-de Boer, Kennedy Ngowi, Elizabeth Moirana, Pythia Nieuwkerk, Francis Pima, Benson Mtesha, Blandina T. Mmbaga, Eva Muro, Rob Aarnoutse Kilimanjaro Clinical Research Institute, Moshi, Tanzania Kilimanjaro Christian Medical Centre, Moshi, Tanzania UMC Amsterdam – Location AMC, the Netherlands Radboud University Nijmegen, the Netherlands

2 Background (1) Adherence to ARV is challenging
>95% of doses is needed Prevent drug resistance and treatment failure Early detection of limited adherence is needed Health care staff needs to have good insight in adherence to ARV treatment

3 Background (2) Adherence measurement challenging No Golden standard
Direct: drug levels in blood Indirect Self-report Pharmacy refill counts Visual analogue scales Real Time Medication Monitoring No Golden standard

4 Objectives To what extent do pharmacy refill counts represent true levels of medication intake? 1. What is the relationship between pharmacy refill counts adherence and self- reported adherence? 2. What is the relationship between pharmacy refill counts adherence and adherence measured with real time medication monitors?

5 Methodology (1) Data from randomized Clinical Trial: REMIND
To investigate improvement of adherence and treatment outcome 3 arms RTMM SMS Control Outcomes: adherence and viral load

6 RTMM: Wisepill

7 Processes in RTMM

8 Methodology (2) Data from screening, enrolment and first follow-up visit Adherence measurements Self-report: Reported missed pills in the past month Pharmacy refills: number of days with pills taken divided by the number of days between visits RTMM: number of days with pills taken divided by the number of days between visits Missing pharmacy refill counts: assumption is 100% Spearman correlation coefficients

9 Results (1) 42 PLHIV Mean adherence Adherence less than 95%
Pharmacy refill: 91% (SD 20.4) Self-report: 97% (SD 31.2) RTMM: 84% (SD 28.2) Adherence less than 95% Pharmacy refill: 19% Self-report: 17% RTMM: 48% 67% had less than 95% adherence in any of the methods

10 Results (2) Pharmacy refill Self-report RTMM - 0.14 (0.15) 0.08 (0.62)
0.22 (0.14)

11 Discussion Each measures different aspects of adherence
Self-report: overestimation Pharmacy refill counts: overestimation Sharing of pills Pills getting lost Forgetting to take pills for refill count Others RTMM adherence could be underestimation Bulk of pills taken out of the box

12 Recommendation Assessment of adherence needs combined methods
Improved instructions on pharmacy refill counts are needed RTMM is a promising way of getting more comprehensive determination

13 Acknowledgements Study coordinator: Kennedy Ngowi
Study team, specifically study nurses Participants KCMC & KCRI administration EDCTP The EDCTP2 programme is supported under Horizon 2020, the European Union’s Framework Programme for Research and Innovation.

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