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Correlation of Adherence by Pill Count, Self-report, MEMS and Plasma Drug Levels to Treatment Response Among Women Receiving ARV Therapy for PMTCT in Kenya

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Abstract

Success of antiretroviral therapy depends on adherence to effective treatment. We evaluated four adherence methods and their correlation with immunological and virologic response among women receiving PMTCT. Univariable and multivariable analyses were used to assess how adherence by pill count (n = 463), self-report (n = 463), MEMS (n = 129) and plasma drug level (n = 89) was associated with viral load suppression within a 6 months period. Longitudinal analysis was performed to determine the correlation of CD4 cell count with each measure of adherence. For all measures of adherence, sustained viral suppression was less likely for participants in the lowest category of adherence. Although CD4 cell count increased substantially over time, there was no significant association with adherence by the methods. Multiple strategies can be used successfully to monitor treatment adherence. Persons with ≥95% adherence by any method used in this study were more likely to have a favorable treatment outcome.

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Acknowledgements

The authors appreciate the vital contributions made by Barbara Wittwer, Jean-Michel Biollaz and the Aardex Group Ltd. in opening the MEMS database and providing supporting software. We also wish to thank the Kisumu breastfeeding study staff for their diligent work, and study participants for their time. This paper is published with the approval of the Director of KEMRI.

Author’s Contributions

VM contributed throughout the implementation, analysis and writing. RG contributed to the writing and provided statistical analysis. SG conducted the data analysis. RN and FA contributed to data collection. CZ performed the laboratory assays and analysis. TT initiated the study and contributed to the design and implementation. SL contributed to the analysis and writing. All authors read and approved the final manuscript.

Funding

Funding for the study was provided by the Kenya Medical Research Institute (KEMRI) through a cooperative agreement with the US Centers for Disease Control and Prevention (CDC). The study design, data collection instruments, data collection, data analysis, decision to publish and preparation of the manuscript were led by CDC and KEMRI staff based in Atlanta and at the KEMRI/CDC Field Station in Kisumu, Kenya.

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Authors and Affiliations

  1. HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya

    Victor Mudhune, Richard Ndivo & Frank Angira

  2. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop G-45, Atlanta, GA, 30333, USA

    Roman Gvetadze & Shirley Lee Lecher

  3. ICF International, Atlanta, GA, USA

    Sonali Girde

  4. Centers for Disease Control and Prevention, HIV Research Branch, Kisumu, Kenya

    Clement Zeh & Timothy Thomas

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  1. Victor Mudhune
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  2. Roman Gvetadze
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Correspondence to Shirley Lee Lecher.

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The findings and conclusions in this report are those of the authors and do not necessarily represent the views of their institutions, including the Centers for Diseases Control and Prevention and Kenya Medical Research Institute.

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Mudhune, V., Gvetadze, R., Girde, S. et al. Correlation of Adherence by Pill Count, Self-report, MEMS and Plasma Drug Levels to Treatment Response Among Women Receiving ARV Therapy for PMTCT in Kenya. AIDS Behav 22, 918–928 (2018). https://doi.org/10.1007/s10461-017-1724-7

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