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Standard measures are inadequate to monitor pediatric adherence in a resource-limited setting

Alexandra D Müller1, Heather B Jaspan, Landon Myer

  • 1Universitätsmedizin, Georg-August University, Göttingen, Germany. alexdmueller@gmail.com

AIDS and Behavior
|October 19, 2010
PubMed

Insights

Objective adherence measures like MEMS are costly and don't always reflect accurate pediatric antiretroviral treatment timing. Cheaper electronic monitoring is needed for resource-limited settings.

Area of Science:

  • Pediatric infectious diseases
  • Pharmacoeconomics
  • Global health

Background:

  • Accurate adherence monitoring is crucial for effective pediatric antiretroviral treatment (ART).
  • Objective measures are often preferred but can be costly and complex.
  • Subjective measures are simpler but may lack precision.

Purpose of the Study:

  • To compare the utility and cost-effectiveness of objective and subjective adherence measures for pediatric ART.
  • To evaluate the accuracy of pharmacy refill (PR), returned syrups (RS), caregiver self-report (3DR), and Visual Analogue Scale (VAS) against the Medication Event Monitoring System (MEMS).

Main Methods:

  • A 1-month longitudinal study involving 53 caregiver-child dyads in a South African primary care facility.
  • Comparison of adherence data from PR, RS, 3DR, and VAS with MEMS.
  • Cost analysis of each adherence monitoring method.

Main Results:

  • High adherence rates reported by VAS (100%), 3DR (100%), PR (100%), and RS (103%).
  • MEMS indicated 92% of doses administered, but only 66% within the prescribed 12-hour interval.
  • No significant correlation found between PR, RS, 3DR, VAS, and MEMS.
  • MEMS was the most expensive adherence monitoring tool.

Conclusions:

  • Subjective and pharmacy-based adherence measures do not accurately reflect the timing accuracy of pediatric ART doses.
  • MEMS highlights significant deviations in dose timing, which requires better monitoring strategies.
  • Development and accessibility of cost-effective electronic monitoring devices are essential for resource-limited settings.

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