*Purpose: Several studies report a high prevalence of inadequate adherence to prescribed (R_x) immunosuppressive (IS) medication regimens among kidney transplant (KT) recipients, yet few interventions have been effective for helping patients sustain appropriate R_x use and achieve optimal transplant outcomes. We describe the implementation of a multifaceted, evidence-based, medication adherence monitoring strategy (‘TAKE IT’) that leverages available transplant center resources to intervene with patients earlier and prevent further complications that could result from inadequate regimen adherence.Several studies report a high prevalence of inadequate adherence to prescribed (R_x) immunosuppressive (IS) medication regimens among kidney transplant (KT) recipients, yet few interventions have been effective for helping patients sustain appropriate R_x use and achieve optimal transplant outcomes. We describe the implementation of a multifaceted, evidence-based, medication adherence monitoring strategy (‘TAKE IT’) that leverages available transplant center resources to intervene with patients earlier and prevent further complications that could result from inadequate regimen adherence.

*Methods: The TAKE IT strategy includes: 1) routine, online patient self-report adherence assessments; 2) care alert notifications via the electronic health record (EHR) directed to a transplant nurse; 3) quarterly adherence reports to monitor tacrolimus values and summarize adherence trends; 4) deployment of adherence support tools tailored to specific adherence concerns. A two-arm, patient-randomized trial is underway at Northwestern University and the Mayo Clinic (Scottsdale); 130 of 700 KT recipients have been recruited. To evaluate the initial fidelity of the TAKE IT strategy, we investigated to what extent participants in the intervention arm completed online adherence assessments, and described the prevalence and nature of adherence concerns to date.

*Results: Among 61 patients randomized to receive the TAKE IT intervention, 75% completed the initial online self-report adherence assessment. Over the first three-month period, 74% of intervention participants completed at least two assessments. In all, 51% of patients were considered at risk of inadequate adherence. Among all identified adherence concerns, 31% were classified as cognitive (e.g. forgetfulness), 25% psychological (e.g. depression, low activation), 17% medical, 4% regimen-related (e.g. side effects), 15% social (e.g. unmet support needs), and 8% economic. In nearly all patients with reported concerns, transplant center staff responded and resolved the issue.

*Conclusions: The TAKE IT trial presents an innovative, and at present, reliable approach to monitoring medication adherence among KT recipients and mobilizing transplant center clinicians.

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