Marseille 2007
| Abstract #134 - Unannounced Home-Based Pill Counts Conducted by Telephone: Assessment Development and Validation | ||||
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Session: 24.7: Adherence (Parallel) on Monday @ 16.30-18.30 in HC Chaired by Ana Josefina Guell, Rahul Battcharya Authors: Presenting Author: Ms Lisa Eaton - University of Connecticut, United States |
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| Additional Authors: Dr Seth Kalichman, Ms Lisa Eaton, Ms Christina Amaral, Mrs Jody Flanagan, Ms Heidi Stearns, Mr Chauncey Cherry, Ms Denise White, Ms Demetria Cain, Ms Moira Kalichman, | ||||
| Aim: There are few objective methods for measuring medication adherence. One promising approach to assessing adherence is the home-based unannounced pill count (UPC) conducted monthly in the patient's home. UPC resolves limitations of office-based pill counts by assuring that all medications are present and eliminating the risk of pill dumping. However, UPC has only thus far been used in San Francisco and Uganda; areas where large concentrations of people living with HIV/AIDS live in close proximity. The feasibility of UPC in sprawling urban areas and rural settings has not been demonstrated. | ||||
| Method / Issue: The current study adapted Bangsberg's UPC protocol by using telephone assessment procedures; 92 men and women living with HIV throughout metropolitan Atlanta GA received monthly phone-based UPC over a 6 month period. The telephone pill counting protocol was developed in exact parallel to Bangsberg's home visit procedures. | ||||
| Results / Comments: Phone-based UPC obtained an overall mean adherence of 83.5% (SD=20.2 ; median = 90%) pills taken; 36% of participants had taken less than 85% of ARV medications and 25% were less than 78% adherent. Adherence determined by phone-based UPC was significantly correlated with viral load (r = .-.26, p <.05). Participants with an undetectable viral load were on average 86% adherent compared to 77% for participants with detectable viral loads (p < .05). In addition, we conducted standard home based UPC visits with each participant to validate the phone-based UPC. Validation visits demonstrated strong concordance (> 96%) between the phone-based UPC and the home-based count. A cost analysis showed that the limited error rate for phone-based UPC is tolerable given the cost savings of phone visits versus home visits. | ||||
| Discussion: Home-based UPC remains a valuable method for objectively assessing medication adherence. However, when infeasible because of cost, geography, and other logistical constraints, phone-based UPC offers an economical and easily implemented objective assessment of medication adherence for research and clinical monitoring of adherence. | ||||
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