Returning of antiretroviral medication dispensed over a period of 8\xa0months suggests non-adherence despite full adherence according to real time medication monitoring

Kennedy Michael Ngowi,Peter Reiss,Rob E Aarnoutse,Mirjam A G Sprangers,Lydia Masika,Pythia T Nieuwkerk,Furaha Lyamuya,Blandina T Mmbaga,I Marion Sumari-De Boer,Eva Muro

doi:10.1186/s12981-020-00313-z

Abstract

Real-time medication monitoring (RTMM) may potentially enhance adherence to antiretroviral treatment (ART). We describe a participant in an ongoing trial who, shortly after completing trial participation, died of cryptococcal meningitis despite high levels of adherence according to self-report, pill-counts and RTMM (> 99%). However, she evidenced consistently high HIV viral load throughout the 48-week study follow-up. Subsequently, her relatives unsolicitedly returned eight months’ dispensed ART medication that she was supposed to have taken. This brief report illustrates the challenges of adherence measurements including RTMM, and reinforces the need to combine adherence assessments with viral load monitoring in HIV care.

Highlights

Sustained adherence to antiretroviral treatment (ART) at levels over 95% among people living with HIV (PLHIV) is required in order to prevent treatment failure and the emergence of drug resistance [1]
*Correspondence: k.ngowi@kcri.ac.tz 1 Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania Full list of author information is available at the end of the article condemning being non-adherent, and (4) counselling provided by study staff that may discourage openness, or alternatively, may be too permissive making misreporting easy [3, 4]
Trial The trial aims to investigate the effect of two mobile health strategies, real time medication monitoring (RTMM) and use of short message service (SMS), Ngowi et al AIDS Res Ther (2020) 17:57 on adherence to treatment among PLHIV in Kilimanjaro, Tanzania

Summary

Introduction

Sustained adherence to antiretroviral treatment (ART) at levels over 95% among people living with HIV (PLHIV) is required in order to prevent treatment failure and the emergence of drug resistance [1]. *Correspondence: k.ngowi@kcri.ac.tz 1 Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania Full list of author information is available at the end of the article condemning being non-adherent, and (4) counselling provided by study staff that may discourage openness, or alternatively, may be too permissive making misreporting easy [3, 4]. Trial The trial aims to investigate the effect of two mobile health (mHealth) strategies, real time medication monitoring (RTMM) and use of short message service (SMS), Ngowi et al AIDS Res Ther (2020) 17:57 on adherence to treatment among PLHIV in Kilimanjaro, Tanzania.

Results

Conclusion