Abstract
The measurement of adherence to antiretroviral medications has become a major focus of HIV research. Accurate means of assessing adherence is critical. The HIV epidemic has provided unique challenges in the quest to accurately determine adherence to medications. The strengths and weaknesses of the most common means for assessing adherence are briefly reviewed. Case studies from a research study assessing adherence in alcohol abusing patients with HIV are presented to illustrate the actual use of the Medication Events Monitoring System (MEMS) and patient self-report in a clinical research setting. Practical recommendations for optimizing measurement of adherence are provided. In research studies examining adherence to HIV medications, MEMS's potential to provide detailed accurate adherence information may be quite limited because of the complexity of the regimen, patient lifestyle factors, and the use of adherence aids such as pill boxes. Innovative measurement of medication adherence remains a critical research priority.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Averbuch, M., Weintraub, M., and Pollock, D. J. (1990). Compliance assessment in clinical trials: the MEMS device. Journal of Clinical Research and Pharmacoepidemiology, 4, 199–204.
Broers, B., Morabia, A., and Hirschel, B. (1994). A cohort study of drug users' compliance with zidovudine treatment. Archives of Internal Medicine, 154, 1121–1127.
Caron, H. S., and Roth, H. P. (1968). Patients' cooperation with a medical regimen. Journal of the American Medical Association, 203, 922–926.
Chesney, M. A., Ickovics, J. R., Hecht, F. M., Sikipa, G., and Rabkin, J. (1999). Adherence: A necessity for successful HIV combination therapy. AIDS, 13 (suppl A), S271-S278.
Cheung, R., Sullens, C. M., Seal, D., Dickins, J., Nicholson, P. W., Deshmukh, A. A., Denham, M. J., and Dobbs, S. M. (1988).The paradox of using a 7 day antibacterial course to treat urinary tract infections in the community. British Journal of Clinical Pharmacology, 26, 391–398.
Condra, J. H., Schleif, W. A., Blahy, O. M., Gabryelski, L. J., Graham, D. J., Quintero, J. C., Rhodes, A., Robbins, H. L., Roth, E., Shivaprakash, M., Titus, D., Yang, T., Teppler, H., Squires, K. E., Deutsch, P. J., and Emini, E. A. (1995). In vivo emergence of HIV-1 variants resistant to multiple protease inhibitors. Nature, 374, 569–571.
Deeks, S. G., Smith, M., Holodniy, M., and Kahn, J. O. (1997). HIV-1 protease inhibitors, a review for clinicians. Journal of the American Medical Association, 277, 145–153.
Feely, M., Cooke, J., Price, D., Singleton, S., Mehta, A., Bradford, L., and Calvert, R. (1987). Low-dose phenobarbitone as an indicator of compliance with drug therapy. British Journal of Clinical Pharmacology, 24, 77–84.
Fletcher, S. W., Pappius, E. M., and Harper, S. J. (1979). Measurement of medication compliance in a clinical setting. Comparison of three methods in patients prescribed digoxin. Archives of Internal Medicine, 139, 635–638.
Haynes, R. B., Taylor, D. W., and Sackett, D. L., Eds. (1979). Compliance in health care. Baltimore: John Hopkins University Press.
Hecht, F. M., Colfax, G., Swanson, M., and Chesney, M. (1998, February). Adherence and effectiveness of protease inhibitors in clinical practice. Paper presented at the Fifth Conference on Retroviruses and Opportunistic Infections, Chicago, Illinois.
Ickovics, J. R. (1997, November). Measures of Adherence (Self-Report). Paper presented at Adherence to New HIV Therapies: A Research Conference, National Institutes of Health, Washington, DC.
Ickovics, J. R., and Meisler, A. (1997). Adherence and retention in AIDS clinical trials: A framework for research and application. Journal of Clinical Epidemiology, 50, 385–391.
Kastrissios, H., and Blaschke, T. F. (1997). Medication compliance as a feature in drug development. Annual Review of Pharmacology and Toxicology, 37, 451–475.
Maenpaa, H., Javala, K., Pikrarainen, J., Malleonen, M., Heinonen, O. P., and Mannenen, V. (1987). Minimal dose of digoxin: a new marker for compliance to medication. European Heart Journal, 8(supp 1), 1–7.
Potter, L., Oakley, D., de Leon-Wong, E., and Canamar, R. (1996). Measuring compliance among oral contraceptive users. Family Planning Perspectives, 28, 154–158.
Pullar, T., Kumar, S., Tindall, H., and Feely, M. (1989). Time to stop counting the tablets? Clinical Pharmacology and Therapeutics, 46, 163–168.
Samet, J. H., Libman, H., Steger, K. A., Dhawan, R. K., Chen, J., Shevitz, A. H., Dewees-Dunk, R., Levenson, S., Kufe, D., and Craven, D. E. (1992). Compliance with zidovudine therapy in patients infected with human immunodeficiency virus type 1: a cross-sectional study in a municipal hospital clinic. American Journal of Medicine, 91, 495–499.
Wainberg, M. A., and Friedland, G. (1998). Public health implications of antiretroviral therapy and HIV drug resistance. Journal of the American Medical Association, 279, 1977–1983.
Wall, T. L., Sorensen, J. L., Batki, S. L., Delucchi, K. L., London, J. A., and Chesney, M. A. (1995). Adherence to zidovudine (AZT) among HIV-infected methadone patients: a pilot study of supervised therapy and dispensing compared to usual care. Drug and Alcohol Dependence, 37, 261–269.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Samet, J.H., Sullivan, L.M., Traphagen, E.T. et al. Measuring Adherence Among HIV-Infected Persons: Is MEMS Consummate Technology?. AIDS Behav 5, 21–30 (2001). https://doi.org/10.1023/A:1009503320498
Issue Date:
DOI: https://doi.org/10.1023/A:1009503320498