ADHERENCE TO A SIX-DOSE REGIMEN OF ARTEMETHER-LUMEFANTRINE FOR TREATMENT OF UNCOMPLICATED PLASMODIUM FALCIPARUM MALARIA IN UGANDA

Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether- lumefantrine (Coartem) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio 3.1, 95% confidence interval (CI) 1.1�9.7). Mean lumefantrine blood levels were lower among non-adherent (n 16) (2.76 g/mL, 95% CI 1.06�4.45) than among adherent (n 171) (3.19 g/mL, 95% CI 2.84�3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.