JMIR Publications

ABSTRACT

Background:

Inadequate adherence to prescribed immunosuppressive medication regimens among kidney transplant (KT) recipients is common, yet few interventions have been effective for helping KT patients sustain adequate adherence to immunosuppressive medications and achieve optimal transplant outcomes.

Objective:

We examined the preliminary fidelity of a transplant center-based, multifaceted adherence monitoring approach known as TAKE IT.

Methods:

The TAKE IT strategy includes: 1) routine, online, monthly patient self-report adherence assessments; 2) care alerts directed to nurses; 3) quarterly reports monitoring tacrolimus values and adherence trends; 4) support tools tailored to specific adherence concerns. A 2-arm, patient-randomized trial is underway at 2, large transplant centers (n = 449). To evaluate initial fidelity of TAKE IT, we investigated if patients who completed the initial adherence assessments differed from patients who did not and described the nature of adherence concerns to date.

Results:

Among 202 patients randomized and exposed to TAKE IT for 3-months or more, 81% completed at least 1 adherence assessment, and 73% completed 2-or-more. Overall, 50% had inadequate adherence over the 3-month assessment period. The most common barriers were classified as regimen-related (e.g. regimen complexity), cognitive (e.g. forgetfulness), and medical (e.g. side effects). Higher income participants were more likely to complete all surveys compared to lower income participants (P=0.01).

Conclusions:

TAKE IT demonstrated high uptake in participants’ initial responses and sustained engagement with monthly assessments, among a diverse sample of KT recipients, notably across age, time since transplant, health literacy, and race. Clinical Trial: ClinicalTrials.gov NCT03104868; https://clinicaltrials.gov/ct2/show/NCT03104868.