Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders

Abstract

Background Real-time adherence monitoring is now possible through medication storage devices equipped with cellular technology. We assessed the effect of triggered cell phone reminders and counseling utilizing objective adherence data on antiretroviral (ART) adherence among Chinese HIV-infected patients. Methods We provided ART patients in Nanning, China, with a medication device (“Wisepill”) to monitor their ART adherence electronically. After 3 months, we randomized subjects within optimal (≥95%) and suboptimal (<95%) adherence strata to intervention vs. control arms. In months 4–9, intervention subjects received individualized reminders triggered by late dose-taking (no device-opening by 30 minutes past dose time), and counseling using device-generated data. Controls received no reminders or data-informed counseling. We compared post-intervention proportions achieving optimal adherence, mean adherence, and clinical outcomes. Results Of 120 subjects enrolled, 116 (96.7%) completed the trial. Pre-intervention, optimal adherence was similar in intervention vs. control arms (63.5% vs. 58.9%, respectively; p=0.60). In the last intervention month, 87.3% vs. 51.8% achieved optimal adherence (risk ratio (RR) 1.7, 95% Confidence Interval (CI) 1.3–2.2); mean adherence was 96.2% vs. 89.1% (p=0.003). Among pre-intervention suboptimal adherers, 78.3% vs. 33.3% (RR 2.4, CI 1.2–4.5) achieved optimal adherence; mean adherence was 93.3% vs. 84.7% (p=0.039). Proportions were 92.5% and 62.9% among optimal adherers, respectively (RR 1.5, CI 1.1–1.9); mean adherence was 97.8% vs. 91.7% (p=0.028). Post-intervention differences in clinical outcomes were not significant. Conclusion Real-time reminders significantly improved ART adherence in this population. This approach appears promising for managing HIV and other chronic diseases and warrants further investigation and adaptation in other settings.

Comparison of subjective and objective adherence measures for preexposure prophylaxis against HIV infection among serodiscordant couples in East Africa

“…Short messaging service may allow for more frequent assessment of self-report, thus reducing recall bias, as well as potentially reducing social desirability through the relative anonymity of the technology. Real-time adherence monitoring may improve accuracy of electronic monitoring through rapid identification of technical failures, and also has the added potential for delivery of real-time adherence feedback and/or intervention [32,33]. Pharmacokinetic measures (e.g.…”

Randomized Factorial Trial of Phone-Delivered Support Counseling and Daily Text Message Reminders for HIV Treatment Adherence

“…Although phone-delivered self-regulation counseling may improve adherence, studies repeatedly find patients faced with challenges to maintaining adherence over the long-term. A solution to sustained adherence may be short message service (SMS) text message reminders (17, 18), although the evidence is mixed for the effectiveness of various models (19, 20). Interventions designed to capitalize on low-cost mobile text message reminders to support adherence are promising (21), but have not been tested as a means of sustaining improvements in medication adherence following behavioral counseling.…”

Mobile phone use among female entertainment workers in Cambodia: an observation study

“…mHealth, or mobile health, projects have shown to be increasingly successful in developing countries. Collecting health data (8)(9)(10), increasing access to health knowledge (11)(12)(13)(14), promoting provider quality (15)(16)(17), and increasing medication/appointment adherence (18)(19)(20) are a few ways in which mobile phones have successfully been used in developing countries to support health. In addition, rigorous evaluations have demonstrated mobile phone messages to be successful in supporting preventative healthcare (8,14,18,21,22) such as chronic disease prevention in Seychelles (23).…”