Lyimo R.A., Van Den Boogaard J., Msoka E., Hospers H.J., Van Der Ven A., Mushi D., De Bruin M.
Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, P.O.Box 2236, Moshi, Tanzania; Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands; Maastricht University, Faculty of Psychology and Neuroscience, Netherlands; Kilimanjaro Christian Medical College, Community Health Department, P.O.Box 2240, Moshi, Tanzania; Wageningen University, Communication Science, Netherlands
Lyimo, R.A., Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, P.O.Box 2236, Moshi, Tanzania; Van Den Boogaard, J., Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands; Msoka, E., Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Center, P.O.Box 2236, Moshi, Tanzania; Hospers, H.J., Maastricht University, Faculty of Psychology and Neuroscience, Netherlands; Van Der Ven, A., Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, Netherlands; Mushi, D., Kilimanjaro Christian Medical College, Community Health Department, P.O.Box 2240, Moshi, Tanzania; De Bruin, M., Wageningen University, Communication Science, Netherlands
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. © 2011 Lyimo et al; licensee BioMed Central Ltd.
antiretrovirus agent; adult; article; drug packaging; electronics; evaluation; feasibility study; female; human; Human immunodeficiency virus 1; Human immunodeficiency virus infection; interview; male; methodology; middle aged; patient compliance; statistics; Tanzania; Adult; Anti-Retroviral Agents; Drug Packaging; Electronics; Feasibility Studies; Female; HIV Infections; HIV-1; Humans; Interviews as Topic; Male; Middle Aged; Patient Compliance; Tanzania