Identification of over-compliant patients and pill dumpers with the 'mixed' pill count method at an antiretroviral treatment clinic 
Awolola, Titilope A. and Meyer, Johanna C. and Summers, Beverley and Johnson, Suzanne,African Journal for Physical Health Education, Recreation and Dance, 20, 105-115 (2014),
publicationName = "AFAHPER-SD",
issn = "1117-4315",
abstract= "Near perfect levels of adherence to antiretroviral treatment (ART) are required for maximal viral suppression and avoidance of drug resistance. Pill counts are an objective method of measuring adherence, but can be invalidated if patients manipulate the number of tablets returned. This research aimed to investigate whether the 'mixed' pill count method was capable of identifying patients who were engaging in pill manipulation (dumping) at a public sector antiretroviral (ARV) clinic in South Africa. At baseline, 370 adults on ART were recruited. On the first return visit, a standard/normal pill count was used to calculate adherence and extra tablets were dispensed without the patients' knowledge. At the second return visit, adherence was calculated with the 'mixed' pill count. Patients were grouped into three categories based on calculated adherence: truthfully non-adherent, adherent and over-compliant. Three hundred and forty-four (92.9%) patients completed the study. At the second return visit, with the 'mixed' pill count, 43 patients (12.5%) were identified as over-compliant based on the adherence calculated for their regimens. The 'mixed' pill count identified pill dumpers, although overall adherence was better on the second return visit compared to the first. The significance of this research lies in the fact that it indicates that continuous individual patient counselling and informing patients of their exact adherence score contributed to motivating them to adhere well to their treatment."
language="English",
type="Journal Article"