Using Real-Time Adherence Feedback to Enhance Communication About Adherence to Antiretroviral Therapy: Patient and Clinician Perspectives

Abstract

New technologies for real-time adherence monitoring hold the potential to enhance antiretroviral therapy adherence interventions by providing objective information about daily medication-taking behavior. To realize this potential, we need to understand how to integrate real-time adherence feedback into existing best practices to promote antiretroviral therapy adherence at the point of care. Using in-depth interviews with 30 HIV-infected patients and 29 HIV care clinicians, our primary aims were to understand patients' and clinicians' perceptions of anticipated benefits and preferred uses of objective feedback to enhance conversations about adherence and to identify concerns about the impact of objective monitoring on patient-clinician relationships and communication. Both patients and clinicians suggested that identifying patterns of nonadherence with real-time feedback could (a) facilitate collaborative adherence problem-solving, (b) motivate patient adherence, and (c) reinforce the importance of optimal adherence. Some clinicians worried that delivery of real-time feedback could imply mistrust of patient-reported adherence and suggested careful framing of monitoring results. A few patients and clinicians were concerned that negative reactions to monitoring could discourage retention in care and reduce adherence motivation. These results indicate the potential of real-time feedback to enhance existing evidencebased adherence interventions targeting the key adherence precursors of adherence information, motivation, and behavioral skills. Guidance for the delivery of real-time adherence feedback should focus on both optimizing adherence and mitigating negative perceptions of adherence monitoring.

Design and Delivery of Real-Time Adherence Data to Men Who Have Sex with Men Using Antiretroviral Pre-exposure Prophylaxis via an Ingestible Electronic Sensor

“…Ingestion data are displayed on this interface, and are accessible to patients via a mobile application, and to researchers and clinicians via an online system (14). By capturing objective medication ingestion data in real time, DPS present a novel method of adherence measurement that can promptly identify episodes and patterns of suboptimal adherence, and that allow for notification to a patient's care team prior to the onset of persistent nonadherence (14,(20)(21)(22).…”

Exploring the Value of Real-Time Medication Adherence Monitoring: A Qualitative Study

“…There are a few studies that have recently identified the benefits of products capturing real-time medication intake data. For example, a qualitative study of human immunodeficiency virus (HIV) patients and clinicians reported that real-time adherence feedback could motivate patients to adhere to their medications and improve collaboration with their healthcare providers [ 22 ]. Pharmacists and pharmacy owners valued that these products might also potentially improve or enhance their role in the medication management process as they would have more insight about a patient’s medication taking due to the accessibility of real-time medication adherence and it might help them develop personalized adherence strategies for their patients in a timely manner.…”

“…A growing body of research is exploring the usability, user experience, and workload involved in using these products by various patient populations, including older adults and people with chronic diseases [ 16 , 17 , 18 , 19 ]. Studies have also explored the views and preferences of healthcare providers about these products and factors affecting the offering of such products for patients [ 20 , 21 , 22 ]. Although these studies reported participants’ perspectives on smart medication adherence products, none of them explored participants’ values related to the availability of real-time monitoring data in a detailed manner.…”

Mass Spectrometry Imaging of Hair Identifies Daily Maraviroc Adherence in HPTN 069/ACTG A5305

“…Our prior work showed that a biomarker of melanin, PTCA, was more strongly correlated with MVC accumulation in hair than more acidic antiretrovirals such as emtricitabine and dolutegravir and suggested that the binding of MVC to melanin may limit its removal from hair strands after chemical hair treatments (21). Binary classification of adherence based on MVC/PTCA normalization was selected to maintain assay applicability across varied hair colors and types, and we prioritized assay specificity in establishing a MVC/PTCA threshold cutpoint differentiating 3 or fewer doses/week from more frequent dosing to avoid misclassification of non-adherence (17). As a result, adherence classification based on the selected cutpoint can be considered conservative for differentiating daily and intermittent dosing.…”