Poor adherence to immunosuppressive medications limits renal allograft survival. This randomized controlled trial, evaluated whether young kidney transplant recipients administered a behavioral intervention showed greater taking and timing adherence during a 1-year period than an attention-control group. All participants received a multidose electronic pillbox. The intervention group received education, text-message dose reminders, and quarterly personalized coaching with adherence feedback and action-focused problem-solving to address personal adherence barriers. Adherence was classified as perfect or not for each participant on each day of observation. Perfect taking adherence was defined as taking all prescribed daily doses and perfect timing adherence as taking all prescribed doses within 1 h before or 2 h after the prescribed dosing time. Participants (11-24 y; ≥3 months post-transplant) were recruited from 8 transplant centers across Canada and the USA. Following a 3-month run-in, participants were randomized in age strata (11-13 y., 14-16 y., 17-19 y., 20-24 y.), by center, in blocks of 4. Eighty-one participants were randomized to the intervention group; 9 (11%) withdrew before intervention initiation. 88 were randomized to the control group. 59% were male and 67% white. Median age at baseline was 15.8 (IQR 13.2, 17.4) y. Median time since transplant was 3.1 (0.7, 7.5) y. Groups were balanced. Logistic regression with generalized estimating equations to account for repeated measures within each participant compared taking and timing adherence between intervention and control. Intervention participants had a 50% higher likelihood of perfect taking adherence (OR 1.50 [95%CI 1.06, 2.12]) and a 53% higher likelihood of perfect timing adherence (OR 1.53 [95%CI 1.09, 2.13]) than controls. Maintenance of significantly greater medication adherence among intervention participants compared with controls is likely to result in enhanced graft survival.

CITATION INFORMATION: Foster B, Pai A, Furth S, TAKE-IT Investigators The TAKE-IT Intervention Improves Medication Adherence in Adolescent Kidney Transplant Recipients. Am J Transplant. 2017;17 (suppl 3).

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