Little research exists on acceptability issues related to assessments of adherence to ART in resource-poor settings. To help prepare for two large-scale, multisite ART intervention trials, this qualitative study of individuals in Chennai, India (49 men, 11 women; 33 taking ART, 27 not) and Lilongwe, Malawi (5 men, 5 women, all taking ART) examined potential limitations of different types of adherence assessments: an adherence questionnaire, a pill diary, a pillbox, an electronic pill cap, and a medication punch card. Many participants reported that the various assessments would be acceptable. Potential limitations included issues surrounding literacy, the desire to appease one’s medical provider, privacy and stigma, and “cheating.” These potential limitations are similar to the limitations of these assessments in Western settings. However, the data highlight the need to consider individual patient level concerns when assessing ART adherence in different cultural settings. Innovative ways of monitoring adherence while maintaining standardization across sites are required in multisite trials.
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ACKNOWLEDGMENTS
Funding from this project came from a supplement to Grant U01 AI48040-03 (HIV Prevention Trials Unit; Kenneth Mayer, PI) through Family Health International to the first and last authors and from a Fogarty International Training Grant (TW00237; Kenneth Mayer, PI) awarded to Dr. Kumarasamy as the international recipient.The authors would also like to thank Dr. Myron Cohen (P.I. of HPTN 052), Dr. Monica Ruiz, and Dr. Lydia Soto-Torres for their support of this project. We would also like to thank Sudha Raminani and Josh Gagne with their help on technical aspects of the qualitative coding and software system.
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Safren, S.A., Kumarasamy, N., Hosseinipour, M. et al. Perceptions About the Acceptability of Assessments of HIV Medication Adherence in Lilongwe, Malawi and Chennai, India. AIDS Behav 10, 443–450 (2006). https://doi.org/10.1007/s10461-006-9094-6
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DOI: https://doi.org/10.1007/s10461-006-9094-6