van den Boogaard J., Lyimo R.A., Boeree M.J., Kibiki G.S., Aarnoutse R.E.
Radboud University Nijmegen Medical Centre, University Centre for Chronic Diseases Dekkerswald, Nijmeegsebaan 31, 6560 AB, Groesbeek, Netherlands; Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
van den Boogaard, J., Radboud University Nijmegen Medical Centre, University Centre for Chronic Diseases Dekkerswald, Nijmeegsebaan 31, 6560 AB, Groesbeek, Netherlands; Lyimo, R.A., Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Boeree, M.J., Radboud University Nijmegen Medical Centre, University Centre for Chronic Diseases Dekkerswald, Nijmeegsebaan 31, 6560 AB, Groesbeek, Netherlands; Kibiki, G.S., Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania; Aarnoutse, R.E., Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, Nijmegen, Netherlands
Objective: To assess adherence to community-based directly observed treatment (DOT) among Tanzanian tuberculosis patients using the Medication Event Monitoring System (MEMS) and to validate alternative adherence measures for resource-limited settings using MEMS as a gold standard. Methods: This was a longitudinal pilot study of 50 patients recruited consecutively from one rural hospital, one urban hospital and two urban health centres. Treatment adherence was monitored with MEMS and the validity of the following adherence measures was assessed: isoniazid urine test, urine colour test, Morisky scale, Brief Medication Questionnaire, adapted AIDS Clinical Trials Group (ACTG) adherence questionnaire, pill counts and medication refill visits. Findings: The mean adherence rate in the study population was 96.3% (standard deviation, SD: 7.7). Adherence was less than 100% in 70% of the patients, less than 95% in 21% of them, and less than 80% in 2%. The ACTG adherence questionnaire and urine colour test had the highest sensitivities but lowest specificities. The Morisky scale and refill visits had the highest specificities but lowest sensitivities. Pill counts and refill visits combined, used in routine practice, yielded moderate sensitivity and specificity, but sensitivity improved when the ACTG adherence questionnaire was added. Conclusion: Patients on community-based DOT showed good adherence in this study. The combination of pill counts, refill visits and the ACTG adherence questionnaire could be used to monitor adherence in settings where MEMS is not affordable. The findings with regard to adherence and to the validity of simple adherence measures should be confirmed in larger populations with wider variability in adherence rates.
antiretrovirus agent; cotrimoxazole; isoniazid; disease incidence; disease treatment; health geography; model validation; monitoring; questionnaire survey; tuberculosis; adapted AIDS Clinical Trial Group adherence questionnaire; adult; article; Brief Medication Questionnaire; clinical article; directly observed therapy; drug urine level; electronic medical record; female; human; Human immunodeficiency virus infection; longitudinal study; male; Morisky scale; patient attitude; patient compliance; pilot study; questionnaire; rating scale; rural area; screening test; sensitivity and specificity; Tanzania; treatment outcome; tuberculosis; urban area; urinalysis; Adult; Directly Observed Therapy; Female; Humans; Longitudinal Studies; Male; Medication Adherence; Middle Aged; Pilot Projects; Questionnaires; Tanzania; Tuberculosis; Tanzania