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Using the multi-method approach described, 41% of children were classified as high-adherers to vitamins which is comparable to the proportion of children classified as adherent in a US study investigating pharmacy refill adherence and diary data (34% and 22% respectively) [ 3].
Possible explanations for increased virological failure in adolescents include poorer pharmacy refill adherence than adults and lack of social support.
Pharmacy refill adherence was a stronger predictor of virological response than self-reported adherence.
The performance improved when pharmacy refill adherence was combined with immunological response.
Only pharmacy refill adherence and being able to recall diagnosis were significant predictors of immunological outcome.
The correlation of pharmacy refill adherence and virological outcome has been shown previously [ 35].
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As pharmacy refill non-adherence was more strongly associated with a detectable viral load (OR = 4.9; 95% CI 1.9 12.5, P < 0.01) than self-reported non-adherence (OR = 3.0; 95% CI 1.1 7.7, P = 0.03), we only describe the results using pharmacy-refill adherence.
Table 2 shows univariate relationships of possible risk factors for pharmacy refill non-adherence (i.e., adherence <100%).
For the individual patient, clinician decisions as to frequency of viral load monitoring should be informed by psychosocial and neurobehavioral factors [ 1, 17] and self-reported adherence, pharmacy refill data or adherence monitoring [ 18– 20].
Based upon the pharmacy refill criterion for adherence (i.e.,≥80% attendance to study medication refill visits), despite a prolonged 36-month period of prophylaxis, participants in our trial had a 78% adherence rate which is similar to the 69 86% rates reported by other clinical trials that provided 6 months of IPT [16] [18].
Pharmacy refill as an adherence measure over shorter time periods is more pragmatic and implementable [ 19].
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