A Novel Technology to Promote HAART Adherence


Presented as part of Innovations in Adherence Assessments and Interventions symposium at the Second International Conference on HIV Treatment Adherence, Jersey City, NJ, March 28-30, 2007 by Dr. Jane Simoni.

BACKGROUND

Non-adherence has become the Achilles’ heel of antiretroviral therapy, with forgetfulness the most commonly cited factor for missing doses. Initial research has demonstrated the potential of alarm devices to promote medication adherence, but none currently combine alarm capabilities with ease of transport and storage of medications — especially for multiple medications.

METHODS

In a Phase I SBIR-funded study, we developed and tested MedSignals®, a communicating pill case that (1) provides access to up to 4 prescribed medications; (2) prompts correct dosing times and warnings; and (3) records and uploads dosing data to the Internet. In a randomized crossover design, 44 participants on HAART medications alternatively used an alarm-activated (Alarm) or alarm-deactivated (Silent) device for 2 months. A priori outcomes studied were: dose adherence (percentage of prescribed doses taken) and on-time adherence (percentage of prescribed doses taken within 15% of the prescribed dosing times). All lid openings were time-stamped and recorded by sensors within each bin to indicate doses taken. 

RESULTS

Participants: male, 73%; White, 48%; average age: 45 years; average time since their HIV diagnosis: 12.5 years.

On a Likert scale of 1-5 (5 = most favorable), participants rated the device’s ease of use an average of 4.7 and its ability to remind them to take pills an average of 4.5. Dose adherence was not significantly different between the Alarm (105%) and Silent (108%) conditions (p = 0.23). However, for on-time adherence, the recorded percentage of pills taken improved by 10% for the Alarm-activated condition (p= .03). Furthermore, for QD and BID for a single medication, participants took an average of 19% and 9%, respectively, more pills on time for the Alarm-activated than for the Silent condition (p = 0.06), showing the value of the device for improving on-time adherence.

CONCLUSIONS

Preliminary data suggest MedSignals® is a feasible antiretroviral medication reminder device whose alarm capabilities have the potential for significantly improving on-time adherence over “silent” pill devices.