AIDS and Behavior

, Volume 5, Issue 1, pp 21–30 | Cite as

Measuring Adherence Among HIV-Infected Persons: Is MEMS Consummate Technology?

  • Jeffrey H. Samet
  • Lisa M. Sullivan
  • Elizabeth T. Traphagen
  • Jeannette R. Ickovics


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.

AIDS HIV adherence injection drug user MEMS 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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.Google Scholar
  2. 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.Google Scholar
  3. Caron, H. S., and Roth, H. P. (1968). Patients' cooperation with a medical regimen. Journal of the American Medical Association, 203, 922–926.Google Scholar
  4. 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.Google Scholar
  5. 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.Google Scholar
  6. 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.Google Scholar
  7. 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.Google Scholar
  8. 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.Google Scholar
  9. 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.Google Scholar
  10. Haynes, R. B., Taylor, D. W., and Sackett, D. L., Eds. (1979). Compliance in health care. Baltimore: John Hopkins University Press.Google Scholar
  11. 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.Google Scholar
  12. 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.Google Scholar
  13. 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.Google Scholar
  14. Kastrissios, H., and Blaschke, T. F. (1997). Medication compliance as a feature in drug development. Annual Review of Pharmacology and Toxicology, 37, 451–475.Google Scholar
  15. 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.Google Scholar
  16. Potter, L., Oakley, D., de Leon-Wong, E., and Canamar, R. (1996). Measuring compliance among oral contraceptive users. Family Planning Perspectives, 28, 154–158.Google Scholar
  17. Pullar, T., Kumar, S., Tindall, H., and Feely, M. (1989). Time to stop counting the tablets? Clinical Pharmacology and Therapeutics, 46, 163–168.Google Scholar
  18. 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.Google Scholar
  19. 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.Google Scholar
  20. 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.Google Scholar

Copyright information

© Plenum Publishing Corporation 2001

Authors and Affiliations

  • Jeffrey H. Samet
    • 1
    • 2
  • Lisa M. Sullivan
    • 3
  • Elizabeth T. Traphagen
    • 4
  • Jeannette R. Ickovics
    • 4
  1. 1.Section of General Internal Medicine and Clinical AIDS Program, Department of MedicineBoston University Schools of Medicine and Public HealthBoston
  2. 2.Section of General Internal Medicine and Clinical AIDS Program, Department of Social and Behavioral SciencesBoston University Schools of Medicine and Public HealthBoston
  3. 3.Boston University Schools of Medicine and Public HealthBoston
  4. 4.Section of General Internal Medicine and Clinical AIDS Program, Department of MedicineBoston University Schools of Medicine and Public HealthBoston

Personalised recommendations