Measuring adherence to antiretroviral therapy in northern Tanzania: feasibility and acceptability of the Medication Event Monitoring System

Ramsey A Lyimo, Jossy van den Boogaard, Elizabeth Msoka, Harm J Hospers, Andre van der Ven, Declare Mushi, Marijn de Bruin

Research output: Contribution to journalArticle

21 Citations (Scopus)
4 Downloads (Pure)

Abstract

Background
An often-used tool to measure adherence to antiretroviral therapy (ART) is the Medication Event Monitoring System (MEMS), an electronic pill-cap that registers date and time of pill-bottle openings. Despite its strengths, MEMS-data can be compromised by inaccurate use and acceptability problems due to its design. These barriers remain, however, to be investigated in resource-limited settings. We evaluated the feasibility and acceptability of using MEMS-caps to monitor adherence among HIV-infected patients attending a rural clinic in Tanzania's Kilimanjaro Region.

Methods
Eligible patients were approached and asked to use the MEMS-caps for three consecutive months. Thereafter, qualitative, in-depth interviews about the use of MEMS were conducted with the patients. MEMS-data were used to corroborate the interview results.

Results
Twenty-three of the 24 patients approached agreed to participate. Apart from MEMS-use on travel occasions, patients reported no barriers regarding MEMS-use. Unexpectedly, the MEMS-bottle design reduced the patients' fear for HIV-status disclosure. Patients indicated that having their behavior monitored motivated them to adhere better. MEMS-data showed that most patients had high levels of adherence and there were no bottle-openings that could not be accounted for by medication intake. Non-adherence in the days prior to clinic visits was common and due to the clinic dispensing too few pills.

Conclusion
MEMS-bottle use was readily accepted by patients. Although the MEMS-bottle was used accurately by most patients, patients need to be more explicitly instructed to continue MEMS-use when travelling. Even HIV-clinics with sufficient staff and free medication may impose structural adherence barriers by supplying an insufficient amount of pills.
Original languageEnglish
Article number92
Number of pages7
JournalBMC Public Health
Volume11
DOIs
Publication statusPublished - 9 Feb 2011

Keywords

  • adult
  • anti-retroviral agents
  • drug packaging
  • electronics
  • feasibility studies
  • female
  • HIV infections
  • HIV-1
  • humans
  • interviews as topic
  • male
  • middle aged
  • patient compliance
  • Tanzania

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