*Purpose: In 2017, the TAKE IT trial began its evaluation of a multifaceted, technology-enabled, transplant center-based intervention to monitor medication adherence behaviors among Kidney Transplant (KT) recipients, detect and classify adherence concerns, and notify appropriate clinical staff to engage and resolve issues in a timely fashion. The preliminary acceptability and feasibility of leveraging electronic health records and ‘phenotyping’ patients’ medication-taking behaviors were investigated. We previously introduced this clinical trial in 2019; we now share an update of findings pertaining to the fidelity of the TAKE IT intervention.

*Methods: The TAKE IT strategy includes: 1) routine, online patient self-report adherence assessments; 2) care alert notifications directed to a transplant nurse; 3) quarterly adherence reports to monitor tacrolimus values and summarize adherence trends; 4) deployment of support tools tailored to specific adherence concerns. A two-arm, patient-randomized trial is underway at two, large transplant center sites; 442 KT recipients have been consented to the trial. To evaluate the initial fidelity of the TAKE IT strategy, we investigated to what extent patients who completed the initial adherence assessment differed from patients who did not, and described the nature and follow-up of adherence concerns to date.

*Results: In total 187 patients were exposed to the intervention. 73% of participants completed the initial online adherence assessment. There were no significant disparities in age, gender, race, or time since transplant between participants who completed or did not complete the initial assessment. Participants who did not complete the initial assessment had, overall, lower health activation (as measured by the CHAI), lower health literacy, and lower income, compared to participants who completed the initial assessment (all p &lt 0.05). Among those who completed the initial assessment, 39% were at risk for inadequate adherence. Most common barriers were classified as cognitive (11%), medical (7%), and/or psychological (7%). Transplant center staff responded to and addressed 69% of patient-reported concerns.

*Conclusions: The TAKE IT trial continues to demonstrate reliability and potential benefit in monitoring adherence behaviors among KT recipients and engaging transplant center staff to address at-risk patients.

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