Background: Pediatric adherence, which relies not only on the child, but also on his or her caregiver, is especially difficult and may be further complicated when in resource constrained settings. The goals of this study were to describe the rates of pediatric adherence in Nigeria and determine a valid and feasible method for monitoring adherence in resource limited settings.
Methods: A cohort of 229 children ARV naive and ARV experienced and their caregivers were enrolled at 3 pediatric care sites in Nigeria. Demographic and behavioral questionnaires and self report measures of adherence were administered to caregivers. MEMSTM Cap data were collected over a 2 month period as the "gold standard" of adherence. Viral load, refill history, and pill count of dispensed medication were obtained at the end of the observation period.
Results: There was an inverse and robust relationship between the prescribed bottle openings and viral load (-0.5345). This relationship was statistically significant (P = 0.0000). As the total percent of prescribed bottle openings increased, viral load decreased. There was a direct relationship between the total prescribed bottle openings that occurred and pill count adherence (0.2465), and this relationship was statistically significant (P = 0.0029). As the total percent of adherent bottle openings increased, the pill count adherence rate increased. There was an inverse relationship between pill count adherence and viral load (-0.1636), and this relationship was statistically significant (P = 0.0477). As pill count adherence increased, viral load decreased.
Conclusions: Results suggest that of all of the measures employed to assess adherence (self-report, pill count, refill history), pill count was robustly associated with the "gold standard" of MEMSTM adherence rates and viral load. Pill counts appear to be a feasible adherence assessment and monitoring method for pediatric adherence in resource constrained settings and warrants further evaluation.
(C) 2012 Lippincott Williams & Wilkins, Inc.