Thesis(MSc(Med)(Pharmacy))--University of Limpopo (Medunsa Campus), 2011. / High levels of adherence to ART are essential for maximal suppression of viral replication
and avoidance of drug resistance. Pill counts are an indirect, objective method of assessing
adherence. Patients can invalidate pill counts by manipulating the number of tablets
returned. This paper describes a pilot study which investigated the ability of ‘mixed’ pill
counts to detect deliberate masking of non-adherence to ART at a public sector ARV Clinic
in Pretoria, South Africa. Seventy-eight adult patients on a first line regimen of ART were
recruited. At the first return visit, a standard pill count was performed and adherence (% of
tablets taken) was calculated. For the repeat prescription, three days’ extra supply was
dispensed without the patients’ knowledge. At the second return visit, a ‘mixed’ pill count
was performed and adherence was calculated. Patients were grouped into three categories
based on calculated adherence: truthfully non-adherent (<100% adherence), adherent
(100% adherence) and ‘over-compliant’ (>100% adherence, i.e. returning to the clinic with
fewer tablets than required). Exploratory interviews were conducted with truthfully nonadherent
and over-compliant patients to obtain explanations for discrepancies in pill counts.
Twenty-nine (37%) patients completed the study. Reasons for drop-out or discontinuation
from the study included the issue of prescriptions for 2-3 months’ ARV supply, missed
appointments, regimen changes and failure to return remaining tablets to the clinic. Eleven
patients (38%) were identified as over-compliant in one or more of the ARVs in their
regimen. Nine of these patients agreed to be interviewed, of which three admitted to
manipulating their tablet numbers. Reasons for manipulation included: being ’fine now’ and
not in need of ARVs; changes in body shape; possibility of the social grant being terminated
if non-adherent; getting a new supply and no need for remaining ARVs; knowing that the
tablets would be counted for the study. This pilot study indicated that the ‘mixed’ pill count
method is capable of detecting deliberate masking of non-adherence. Applying this method
to a larger sample may better estimate the frequency of pill count manipulation by patients
and help gain insight to reasons for this behaviour and the extent of actual non-adherence.
Key words: dumping, manipulation, masking, over-compliance, HAART
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:ul/oai:ulspace.ul.ac.za:10386/453 |
| Date | January 2011 |
| Creators | Adeyinka, Titilope Adetola |
| Contributors | Meyer, J. C., Summers, B., Johnson, S. |
| Publisher | University of Limpopo (Medunsa Campus) |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | xxxiv, 162 leaves. |
| Relation | Adobe Acrobat Reader, version 6.0 |
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