Randomized Pilot Study of an Advanced Smart-Pill Bottle as an Adherence Intervention in Patients With HIV on Antiretroviral Treatment

Abstract

Background: Adherence is critical to achieve the benefits of antiretroviral therapy. A smart-pill bottle service that transmits real-time adherence data via cellular networks to a central service and prompts nonadherent patients with phone or text messages may improve adherence. Methods: Adults with HIV taking a tenofovir-containing regimen with suboptimal adherence were randomized to adherence counseling ± a smart-pill bottle service for 12 weeks. Tenofovir diphosphate (TFV-DP) levels by dried blood spot, HIV RNA levels, CD4 cell counts, and self-reported adherence were collected. Results: Sixty-three participants (22% women; 48% black, 25% Latino) were randomized: 30 to the smart-pill bottle (2 of whom were lost to follow-up before the baseline visit), and 33 to control arms. At baseline, 49% of participants had HIV RNA ≤20 copies/mL and 61% reported 100% adherence with ART over 4 days. From baseline to week 12, median TFV-DP levels were +252 and −41 fmol/punch in the bottle and control arms, respectively (P = 0.10). Exploratory exclusion of 3 participants with known or suspected drug–drug interactions found median TFV-DP levels of +278 and −38 fmol/punch, respectively (P = 0.04). There were no differences in study discontinuations, HIV RNA suppression, CD4 cell counts, or self-reported adherence at week 12. Conclusions: In a diverse group of participants with suboptimal adherence to ART, the smart-pill bottle service was associated with higher TFV-DP levels.

Effect of a Smart Pill Bottle Reminder Intervention on Medication Adherence, Self-efficacy, and Depression in Breast Cancer Survivors

“…However, in our study, the time period of reminders and reminder methods were somewhat different from those previously used, such as weekly reminders using an app 23 and daily reminders using a smart pill bottle 38 . The present results are in line with those of previous studies reporting a positive impact of smart pill bottle interventions on medication adherence in patients with multiple myeloma 38 and people with HIV 32 …”

“… 38 The present results are in line with those of previous studies reporting a positive impact of smart pill bottle interventions on medication adherence in patients with multiple myeloma 38 and people with HIV. 32 …”

“…The smart pill bottles have several other functions that could promote medication adherence, such as providing a reminder at the scheduled dose time and sending messages to designated helpers if a person is more than 1 hour late for the scheduled dose. [31][32][33] Depressive symptoms have been reported as a barrier to oral endocrine therapy adherence among breast cancer survivors. 14 In a previous study on women with breast cancer, nonadherence to adjuvant oral hormone therapy was 2.3 times higher in patients experiencing depressive symptoms.…”

“…So far, studies using smart pill bottles have been restricted to people living with multiple myeloma, 37 heart failure, 33 and HIV. 32 To the best of our knowledge, no previous studies have explored promoting medication adherence among breast cancer survivors. The purpose of this study was to explore the effects of a smart pill bottle reminder intervention on medication adherence and medication self-efficacy and whether this intervention also alleviates the levels of depressive symptoms among breast cancer survivors undergoing adjuvant oral antiestrogen therapy.…”

Adherencia al tratamiento en personas que viven con VIH: vínculos entre el modelo explicativo, los motivos y las prácticas

“…Finally, the practice of medication intake would be facilitated by behavioral interventions such as the use of external reminders and the incorporation of medication intake into the daily routine, within the framework of a continuously assessed adherence process. Interventions using smart pill dispensers that transmit real-time data on adherence and send telephone or text messages to nonadherent patients for facilitating medication intake are promising (38), especially at the start of treatment. Furthermore, pharmacological adherence suggests a personalized evaluation of the various areas of care in order to channel the corresponding specialists for detecting difficulties.…”