Antiretroviral concentrations in small hair samples as a feasible marker of adherence in rural Kenya

Matthew D. Hickey, Charles R. Salmen, Robert A. Tessler, Dan Omollo, Peter Bacchetti, Richard Magerenge, Brian Mattah, Marcus R. Salmen, Daniel Zoughbie, Kathryn J. Fiorella, Elvin Geng, Betty Njoroge, Chengshi Jin, Yong Huang, Elizabeth A. Bukusi, Craig R. Cohen, Monica Gandhi

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Antiretroviral hair levels objectively quantify drug exposure over time and predict virologic responses. We assessed the acceptability and feasibility of collecting small hair samples in a rural Kenyan cohort. Ninety-five percentage of participants (354/373) donated hair. Although median self-reported adherence was 100% (interquartile range, 96%-100%), a wide range of hair concentrations likely indicates overestimation of self-reported adherence and the advantages of a pharmacologic adherence measure. Higher nevirapine hair concentrations observed in women and older adults require further study to unravel behavioral versus pharmacokinetic contributors. In resource-limited settings, hair antiretroviral levels may serve as a low-cost quantitative biomarker of adherence.

Original languageEnglish
Pages (from-to)311-315
Number of pages5
JournalJournal of Acquired Immune Deficiency Syndromes
Issue number3
StatePublished - Jul 1 2014


  • Adherence
  • Feasibility and acceptability
  • Hair concentrations
  • Nevirapine
  • Pharmacologic measure
  • Resourcelimited setting


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