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This method provides minimal room for bias, e.g. by socially acceptable patient response (patient self-report), misjudgement of patient behaviour (adherence questionnaires) and overestimation of adherence based on pharmacy refill data (refill rate, persistence) [ 13, 59, 60].
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We sent a fax to each patient's pharmacies to acquire the data of refilling each ARV medication for the entire period since the particular patient had started the current cART-regimen.
Medication adherence was examined using a validated self-reported measure but was not verified by pill counts, refill data, or data from electronically enabled medication bottles/caps.
Adherence to enzyme supplements, vitamins and chest physiotherapy was assessed using a multi-method approach including; Medication Adherence Report Scale, pharmacy prescription refill data and general practitioner prescription issue data.
Most importantly, the ultimate effect of the intervention is determined by analyzing pharmacy refill data, since for the control group no RTMM data is available.
Differences in adherence between the intervention groups and control group are studied using refill data.
We calculated mean adherence based on self-report and on pharmacy refill data.
We determined average adherence to ART using monthly pharmacy refill data.
Treatment gaps (interruptions in pharmacy refill data) of > 90 days were considered regimen discontinuations.
We compared several methods of calculating adherence from pharmacy refill data over differing periods.
Previous studies have validated this method of measuring ART adherence using pharmacy refill data [ 10].
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