Adherence & Retention
MEMS-use for adherence monitoring in resource poor settings
Dear all,
I wondered what other people think about the results of this feasibility study. Particularly:
1- Part of the patients I work with in the Netherlands have some issues with MEMS-design (looks like pill bottle: 'others may ask questions'). I expected this to be worse in Tanzania where fear for status disclosure seems considerably higher. Yet, patients thought the bottles reduced stigma (looks like lotion bottle; no sticker on it with medication names). Is this something others have observed as well?
2- Whereas most people use the MEMS very well, a number has periods with suboptimal use. Upon inquiring on MEMS-use, half of them admitted inaccurate use. The other half "admitted" after a look at the data. This implies that with EM devices, it is useful to go beyond specific questions, and also discuss the actual reports (at the end of the study, for example) in order to separate inaccurate EM-use from inaccurate pill use. We noticed the value of this exercise previously as well in a trial with 133 Dutch patients. Do other researchers also use this strategy (discuss actual reports) to separate non-EM-use from non-pill-use? Which rules do you use to 'objectivy' this?
3- The MEMS seemed to have a notable effect on adherence; perhaps also due to the manner of introduction by the local researchers. In studies, this may introduce bias. In clinical practice, however, the intervention effect could be very useful (and may be larger if you use the data in discussion with patients: e.g. see refs below). Moreover, with infrequent CD4 measures (chemicals out of stock) and no viral loads, the data can also be helpful for diagnostic purposes. Have others already used such data in that form in settings with no viral loads, drug levels, etc?
Interested in hearing your thoughts on this.
Marijn
Resources:
http://www.ncbi.nlm.nih.gov/pubmed/19771504
Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China.
Sabin LL, DeSilva MB, Hamer DH, Xu K, Zhang J, Li T, Wilson IB, Gill CJ.
http://www.ncbi.nlm.nih.gov/pubmed/20658830
Electronic monitoring-based counseling to enhance adherence among HIV-infected patients: a randomized controlled trial.
de Bruin M, Hospers HJ, van Breukelen GJ, Kok G, Koevoets WM, Prins JM.
Attached resource:
Ann Williams
Dear Marijin,
I think the issues you mention, both pro and con, are typical of the
challenges working with MEMS.
I'm attaching an article that Carol Bova wrote some time ago summarizing
the problems and making suggestions for addressing them, which you might
find helpful.
The technology is evolving quickly, but a lot of the problems are similar.
Best,
Ann
--
Ann Bartley Williams
Emeritus Professor of Nursing
12:45 PM, 18 Feb 2011 | Permalink
Ann Williams
Hi,
Here's the article I mentioned.
Best,
Ann
Attached resource:
Source: UCLA School of Nursing
Keywords: e.g. malaria, food security, malawi
1:04 PM, 18 Feb 2011 | Permalink
Marijn de Bruin
Dear Ann,
that's an interesting article indeed. It does observe many of the issues we also encountered in the Netherlands. In the Tanzanian context, however, the situation was somewhat different: a- no week boxes, b- no pill bottle openings not accounted for by pill intake. And one of the major barriers we observed among Dutch HIV-patients specifically, due to fear for disclosure, was not taking the bottle along in public areas. We observed the opposite in the Tanzanian study: people felt more comfortable carrying the bottle around as compared with their usual bottle. The only real barrier in this context seemed to be fear for the bottle being stolen on long trips.
But both studies show us that we should carefully check the quality of the data, and that studies exploring the relation between adherence and viral loads with MEMS caps should be aware that the required level of adherence for viral suppression is probably (somewhat) higher than observed.
Best wishes,
Marijn
5:39 AM, 20 Feb 2011 | Permalink