Pill count is used to assess drug adherence in people living with human immunodeficiency virus (PLHIV), but carrying a pillbox is associated with stigma and fear of concealment and might indicate poor adherence. As such, Robert Ndege, from the Ifakara Health Institute and St. Francis Referral Hospital in Ifakara, Tanzania, and a team of researchers examined pillbox returns in rural Tanzania and a higher associated risk of being lost to follow-up (LTFU).

This nested study included a total of 2,552 PLHIV in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) who were ≥18 years and had been on antiretroviral treatment (ART) for six or more months. The researchers used Kaplan Meier and Cox models to determine associations between failure to present a pillbox at a clinical follow-up visit and the patient being LTFU.

Over a 33.1 month median follow-up (interquartile range [IQR]: 17.5–52.4), 909 participants (35.6%) were LTFU, 43 died, and 194 transferred clinics. The investigators estimated that the possibility of being LTFU at 24 months was 30% in PLHIV who failed a pillbox return (95% confidence interval [CI], 26.8–33.2%) versus 19.4% in those who did not fail (95% CI, 17.4–21.6%).

In closing, the study’s authors affirmed an association between failure to present a pillbox for adherence assessment and falling off treatment, and suggested that this “could be used as a simple tool to identify PLHIV for appropriate interventions to reduce their chance of being LTFU.”

Source: HIV Medicine