Real-Time Reminders Plus Counseling Improve Adherence to Antiretroviral Therapy

A combination of real-time cell phone reminders with monthly counseling can significantly improve adherence to antiretroviral therapy (ART), according to a new study.

“A real-time, personalized feedback intervention that delivers triggered reminders plus data-informed counseling as backup improves on-time adherence to ART,” said lead author Lora Sabin, PhD, from Boston University School of Public Health.

The real-time monitoring device, triggered by a Wisepill Web-linked medication container, sends a text reminder to patients if they do not open their pill container within 30 minutes of a scheduled dose. This intervention improved adherence for both high-adhering and low-adhering patients, Dr Sabin said.

In a previous study, researchers had found that electronic drug monitoring-informed counseling significantly improved ART adherence and CD4 counts. “Electronic drug monitoring-guided adherence support works, but it is limited. It doesn’t provide real-time behavioral feedback,” she said.  

Dr Sabin reported on the China Adherence Through Technology Study, which enrolled 120 Chinese patients; 116 patients completed the study. All of them were given a Wisepill Web-linked medication container for 1 antiretroviral medication. Their adherence was tracked for 3 months. Optimal adherence was defined as compliance with the medication regimen at least 95% of the time.

The study also noted the impact on clinical markers, including the mean change in CD4 cells and undetectable viral load. 

At 3 months, about 92% of patients achieved optimal adherence. They were then randomized to an intervention or control group. The 61 patients in the intervention group received a text reminder whenever their device failed to open within 30 minutes of a scheduled dose. The adherence data was discussed during a monthly counseling session. The 55 patients in the control group received no text messages, and Wisepill adherence data were not discussed during the monthly counseling session.

At month 9, mean overall adherence was better in the intervention group (96.4%) than in the control group (89.2%) and more patients in the intervention group (88.5%) than in the control group achieved optimal adherence (52.7%). Mean adherence was better in the intervention group (92.1%) than in the control group (60.5%) both for patients who had optimal adherence at 3 months and for those who did not (82.6% in intervention group versus 35.3% in control group).

For patients who had failed to take their dose within 30 minutes, compliance improved more during the subsequent 30 minutes in the intervention group (56%) than in the control group (43%). Dr Sabin believes this signifies that immediate feedback seems to have a real impact on adherence rates.

“The tools exist to eliminate HIV, but non-adherence is common. Non-adherence contributes to drug resistance. Ways to improve adherence are urgently needed,” she said. The study results provide evidence that triggered reminders can influence adherence rates in HIV-positive patients, Dr Sabin said. “The results were especially promising in low adherers. There was no evidence of impact on CD4 counts,” she said.  
 

Dr Sabin presented the results of the study on June 9, 2014 at the 9th International Conference on HIV Treatment and Prevention Adherence. (Abstract 493)