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Electronic monitoring of antiretroviral adherence in "real time" boosts pill taking and need for intensive adherence support
Michael Carter, 2016-12-05 07:40:00
monitoring of antiretroviral adherence in “real time” significantly increases
the proportion of treatment doses taken on time and reduces the frequency of
treatment interruptions, according to a Ugandan study published in AIDS.
The study had an observational
design. Patients switched from electronic adherence monitoring (EAM) – which stores information about the date and
time pill containers are opened for later download to a computer – to real-time
EAM, with data about opening of containers transmitted instantly via wireless
networks. Average adherence levels increased from 84% with standard EAM to 94%
after switching to real-time EAM. This increase was sustained during the six
months following the switch. With both types of EAM, patients received support
in the event of prolonged treatment interruptions.
standard EAM, real-time EAM plus home visits for sustained interruptions was
associated with increased average adherence and fewer adherence interruptions –
both of which are associated with viral suppression and reduced immune
activation,” comment the authors. But switching to real-time EAM did not
increase rates of viral suppression.
pill-taking schedules is key to the success of antiretroviral therapy. EAM is
widely used to monitor adherence. However, as data gathered using EAM is only
downloaded at clinic visits, ongoing intermittent adherence and/or sustained
treatment interruptions can only be detected retrospectively, meaning that viral rebound may already have occurred by the time adherence problems
are identified. The development of real-time EAM means that missed doses and interruptions
can be detected immediately. This means that electronic reminders can be instantly
sent to patients, and when necessary, more intensive adherence support can be
Uganda wanted to see if switching from standard to real-time EAM was associated
with increased adherence to HIV therapy; if any increases were sustained over
six months; and if real-time EAM reduced the frequency of home visits to
investigate sustained treatment interruptions (48 hours or more).
A total of 112
people were recruited to the study. Median age was 36 years, 68% were female
and 82% were literate. Median CD4 count before the initiation of HIV therapy
was 141 cells/mm3.
monitored for six months using standard EAM. During this period, patients took
an average of 84% of their doses. After the switch to real-time EAM, average
adherence increased significantly to 93% (p < 0.001). This increase was
sustained over the next six months. The mean number of treatment interruptions
lasting 48 hours or more decreased from 2.2 in the standard EAM period to 0.7
after the change to real-time EAM.
There were no
significant socio-demographic or behavioural changes between the standard EAM
and real-time EAM periods.
to real-time EAM did not increase rates of viral suppression. “Overall high
adherence reduced the ability to show a difference in viral suppression between
the monitoring periods,” explain the authors.
An additional 255
people had only real-time EAM. Their adherence
level was almost identical to that observed in the people who switched from
standard EAM (92% vs 93%). However, the mean number of per-patient 48 hour (or
longer) treatment interruptions was higher for individuals starting therapy with
real-time EAM than those who switched (1.9 vs 0.7; p < 0.001).
real-time EAM plus follow-up was high regardless or prior experience with
standard EAM, suggesting that a real-time approach may effectively promote
adherence during early and chronic treatment,” comment the authors. “Our
findings strengthen growing evidence that real-time EAM with follow-up
triggered by incomplete adherence is an effective intervention.”