Use of an on-line pager system to increase adherence to antiretroviral medications

Abstract

Adherence to antiretroviral therapy is critical for treatment success. Antiretroviral therapy typically requires multiple pills at multiple dosing times. To address this, we tested the feasibility, utility, and efficacy of a customizable reminder system using pagers, which were programmed using web-based technology, to increase and maintain proper adherence in patients with pre-existing adherence problems. After a two-week monitoring period with an electronic pill-cap, participants with less than 90% adherence were randomized to continue monitoring or to receive a pager. The group who received the pagers had greater improvements in adherence from baseline to Week 2 and Week 12 than those who monitored their medications only. However, adherence in both groups at the outcome assessments points was still poor. While the provision of a reminder system helped improve adherence, it is likely that more intensive interventions are required for patients with pre-existing problems.

Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of- care in Kenya

“…Several strategies have been utilised to optimise adherence, for example: self-efficacy building, medication management skills, patient education and use of treatment buddies (Ickovics & Meade, 2002;Nachega et al, 2006;Remien et al, 2005;Sabin et al, in press;Safren, Hendriksen, Desousa, Boswell, & Mayer, 2003 Tuldra et al, 2000;Weber et al, 2004;Wong, Lawrence, Struthers, McIntyre, & Friedland, 2006). These strategies have mainly been evaluated in high-income countries.…”

Formal Analysis of Intelligent Agents for Model-Based Medicine Usage Management

“…More approaches to support medicine usage of patients have been developed. Both in (Greene, 2005) as well as (Floerkemeier and Siegemund, 2003) models are presented that do not simply always send an SMS that medicine should be taken such as proposed by (Safren, et al, 2003). Both approaches only send SMS messages in case the patient does not adhere to the prescribed usage.…”

“…Examples of specific relevant groups include independently living elderly people, psychiatric patients or HIV-infected persons. One of the earlier solutions reported in the literature provides the sending of automatically generated SMS reminder messages to a patient's cell phone at the relevant times; e.g., (Safren, Hendriksen, Desousa, Boswell, and Mayer, 2003). A disadvantage of this approach is that patients are disturbed often, even if they do take the medicine at the right times themselves, and that due to this after some time a number of patients start to ignore the messages.…”

A Prospective Study of Predictors of Adherence to Combination Antiretroviral Medication

“…79 In contrast, in preliminary data from another randomized trial of an on-line paging system, patients receiving paged medication reminders improved their adherence significantly more than controls over 4 weeks. 80 In qualitative studies, HIV-positive patients reported the usefulness of technological adherence aids, but many patients were unaware that such aids existed. 56 The incorporation of these aids into clinical practice may be warranted, given their association with adherence in this prospective study.…”