The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings

Loice Achieng, Helen Musangi, Katherine Billingsley, Sharon Onguit, Edwin Ombegoh, Leeann Bryant, Jonathan Mwiindi, Nathaniel Smith, Philip Keiser

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Pill counts are often used to measure adherence to ART, but there is little data on how they affect adherence. We previously showed a bivariate relationship between clinicians counting pills and adherence in patients receiving HIV care in Kenya. We present a secondary analysis of the relationship between numbers of pill counts and clinical outcomes in resource limited settings Methods: Patients initiating ART at Kijabe Hospital were monitored for the number of discretionary pill counts performed by their clinician in the first 6 months of ART. Subjects were followed for at least 1 year after enrollment. The number of clinician pill counts was correlated to ART adherence. The primary endpoints were time to treatment failure, defined as a detectable HIV-1 viral load, death; or loss to follow-up. Results: Clinician pill counts were done at 68% of clinic visits for 304 subjects. There was a positive correlation between the number of clinician pill counts and ART adherence (r = 0.21, p <0.001). Patients were divided into 3 groups (0 counts, 1 to 3 counts, 4 to 7 counts) and exhibited adherence of 76%, 84%, and 92%, respectively (p = 0.004). Time to treatment failure for these groups was 220 days, 438 days, and 497 days (P<0.01), respectively. Time to virologic failure in living patients remaining in the cohort was longer in those with more pill count (P =0.02). Multi-variate analysis adjusting for co-variates affecting time to treatment failure found that that clinician pill counts were associated with a decreased risk of treatment failure (HR = 0.69, p =0.04). Conclusions: The number of clinician pill count performed was independently associated with better adherence and a decreased risk of treatment failure. The use of clinician pill counts should be further studied as an adherence promoter through a randomized clinical trial.

Original languageEnglish (US)
Article numbere67259
JournalPLoS One
Volume8
Issue number12
DOIs
StatePublished - Dec 5 2013

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Treatment Failure
therapeutics
risk reduction
randomized clinical trials
Therapeutics
viral load
Human immunodeficiency virus 1
endpoints
Kenya
multivariate analysis
Patient Compliance
Ambulatory Care
Viral Load
HIV-1
death
Randomized Controlled Trials
HIV
Multivariate Analysis
methodology

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings. / Achieng, Loice; Musangi, Helen; Billingsley, Katherine; Onguit, Sharon; Ombegoh, Edwin; Bryant, Leeann; Mwiindi, Jonathan; Smith, Nathaniel; Keiser, Philip.

In: PLoS One, Vol. 8, No. 12, e67259, 05.12.2013.

Research output: Contribution to journalArticle

Achieng, L, Musangi, H, Billingsley, K, Onguit, S, Ombegoh, E, Bryant, L, Mwiindi, J, Smith, N & Keiser, P 2013, 'The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings', PLoS One, vol. 8, no. 12, e67259. https://doi.org/10.1371/journal.pone.0067259
Achieng, Loice ; Musangi, Helen ; Billingsley, Katherine ; Onguit, Sharon ; Ombegoh, Edwin ; Bryant, Leeann ; Mwiindi, Jonathan ; Smith, Nathaniel ; Keiser, Philip. / The use of pill counts as a facilitator of adherence with antiretroviral therapy in resource limited settings. In: PLoS One. 2013 ; Vol. 8, No. 12.
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