Real-Time Adherence Monitoring for HIV Antiretroviral Therapy

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Abstract

Current adherence assessments typically detect missed doses long after they occur. Real-time, wireless monitoring strategies for antiretroviral therapy may provide novel opportunities to proactively prevent virologic rebound and treatment failure. Wisepill, a wireless pill container that transmits a cellular signal when opened, was pilot tested in ten Ugandan individuals for 6 months. Adherence levels measured by Wisepill, unannounced pill counts, and self-report were compared with each other, prior standard electronic monitoring, and HIV RNA. Wisepill data was initially limited by battery life and signal transmission interruptions. Following device improvements, continuous data was achieved with median (interquartile range) adherence levels of 93% (87–97%) by Wisepill, 100% (99–100%) by unannounced pill count, 100% (100–100%) by self-report, and 92% (79–98%) by prior standard electronic monitoring. Four individuals developed transient, low-level viremia. After overcoming technical challenges, real-time adherence monitoring is feasible for resource-limited settings and may detect suboptimal adherence prior to viral rebound.

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Most cited references 18

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Non-adherence to highly active antiretroviral therapy predicts progression to AIDS.

Neil R. Clark, D Bangsberg, Andrew Zolopa … (2001)

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Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management.

Heidi Pearson, Carl Frick, David W Pantalone … (2006)

A review of 77 studies employing self-report measures of antiretroviral adherence published 1/1996 through 8/2004 revealed great variety in adherence assessment item content, format, and response options. Recall periods ranged from 2 to 365 days (mode = 7 days). The most common cutoff for optimal adherence was 100% (21/48 studies, or 44%). In 27 of 34 recall periods (79%), self-reported adherence was associated with adherence as assessed with other indirect measures. Data from 57 of 67 recall periods (84%) indicated self-reported adherence was significantly associated with HIV-1 RNA viral load; in 16 of 26 (62%), it was associated with CD4 count. Clearly, the field would benefit from item standardization and a priori definitions and operationalizations of adherence. We conclude that even brief self-report measures of antiretroviral adherence can be robust, and recommend items and strategies for HIV research and clinical management.

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Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population.

M Holodniy, L Sheiner, Melissa A. Moss … (2000)

To examine the relationship between adherence, viral suppression and antiretroviral resistance in HIV-infected homeless and marginally housed people on protease inhibitor (PI) therapy. A cross-sectional analysis of subjects in an observational prospective cohort systematically sampled from free meal lines, homeless shelters and low-income, single-room occupancy (SRO) hotels. Thirty-four HIV-infected people with a median of 12 months of PI therapy. Adherence measured by periodic unannounced pill counts, electronic medication monitoring, and self-report; HIV RNA viral load; and HIV-1 genotypic changes associated with drug resistance. Median adherence was 89, 73, and 67% by self-report, pill count, and electronic medication monitor, respectively. Thirty-eight per cent of the population had over 90% adherence by pill count. Depending on the measure, adherence explained 36-65% of the variation in concurrent HIV RNA levels. The three adherence measures were closely related. Of 20 genotyped patients who received a new reverse transcriptase inhibitor (RTI) when starting a PI, three had primary protease gene substitutions. Of 12 genotyped patients who received a PI without a new RTI, six had primary protease gene substitutions (P < 0.03). A substantial proportion of homeless and marginally housed individuals had good adherence to PI therapy. A strong relationship was found between independent methods of measuring adherence and concurrent viral suppression. PI resistance was more closely related to the failure to change RTI when starting a PI than to the level of adherence.

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Author and article information

Contributors

: 617-495-9353 , 617-495-8231 , jhaberer@partners.org

Journal

Journal ID (nlm-ta): AIDS Behav

Title: AIDS and Behavior

Publisher: Springer US (Boston )

ISSN (Print): 1090-7165

ISSN (Electronic): 1573-3254

Publication date (Electronic): 31 August 2010

Publication date PMC-release: 31 August 2010

Publication date (Print): December 2010

Volume: 14

Issue: 6

Pages: 1340-1346

Affiliations

[1 ]Massachusetts General Hospital Center for Global Health, Boston, MA USA

[2 ]Harvard Initiative for Global Health, 104 Mt. Auburn Street, 3rd floor, Cambridge, MA 02138 USA

[3 ]Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Charlestown, MA USA

[4 ]Mbarara University of Science and Technology, Mbarara, Uganda

[5 ]University of California, San Francisco, San Francisco, CA USA

Article

Publisher ID: 9799

DOI: 10.1007/s10461-010-9799-4

PMC ID: 2974938

PubMed ID: 20809380

SO-VID: dca96f47-c0ec-433e-91c4-69fc49244856

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: antiretroviral therapy,real-time adherence monitoring,wireless technology

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ScienceOpen disciplines: Infectious disease & Microbiology

Keywords: antiretroviral therapy, real-time adherence monitoring, wireless technology

Real-Time Adherence Monitoring for HIV Antiretroviral Therapy

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Abstract

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HIV Self-Testing

Most cited references 18

Non-adherence to highly active antiretroviral therapy predicts progression to AIDS.

Self-report measures of antiretroviral therapy adherence: A review with recommendations for HIV research and clinical management.

Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population.

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