Real-time adherence monitoring for HIV antiretroviral therapy.
Current adherence assessments typically detect missed doses long after they occur. Real-time, wireless monitoring strategies for antiretroviral therapy may provide novel opportunities to proactively prevent virologic rebound and treatment failure. Wisepill, a wireless pill container that transmits a cellular signal when opened, was pilot tested in ten Ugandan individuals for 6 months. Adherence levels measured by Wisepill, unannounced pill counts, and self-report were compared with each other, prior standard electronic monitoring, and HIV RNA. Wisepill data was initially limited by battery life and signal transmission interruptions. Following device improvements, continuous data was achieved with median (interquartile range) adherence levels of 93% (87-97%) by Wisepill, 100% (99-100%) by unannounced pill count, 100% (100-100%) by self-report, and 92% (79-98%) by prior standard electronic monitoring. Four individuals developed transient, low-level viremia. After overcoming technical challenges, real-time adherence monitoring is feasible for resource-limited settings and may detect suboptimal adherence prior to viral rebound.
Haberer
Jessica E
JE
Massachusetts General Hospital Center for Global Health, Boston, MA, USA. jhaberer@partners.org
Kahane
Josh
J
Kigozi
Isaac
I
Emenyonu
Nneka
N
Hunt
Peter
P
Martin
Jeffrey
J
Bangsberg
David R
DR
D023241:Antiretroviral Therapy, Highly Active; D016903:Drug Monitoring / Q000295:instrumentation / Q000379:methods*; D004581:Electronics / Q000295:instrumentation; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D055118:Medication Adherence; D010865:Pilot Projects; D014454:Uganda
J Clin Virol. 2007 Apr;38(4):304-12
17329164
J Acquir Immune Defic Syndr. 2010 Jun;54(2):167-79
20375848
JAMA. 2001 Jul 11;286(2):171-9
11448280
Infect Control Hosp Epidemiol. 2009 Nov;30(11):1090-5
19775238
PLoS One. 2008 Jul 30;3(7):e2783
18665246
J Infect Dis. 2007 Dec 15;196(12):1773-8
18190257
Health Aff (Millwood). 2010 Feb;29(2):252-8
20348069
AMIA Annu Symp Proc. 2008 Nov 06;:1167
18999132
AIDS Behav. 2009 Jun;13 Suppl 1:82-91
19301113
AIDS. 2000 Mar 10;14(4):357-66
10770537
J Biomed Inform. 2010 Feb;43(1):159-72
19615467
Curr HIV/AIDS Rep. 2005 Nov;2(4):200-5
16343379
Stud Health Technol Inform. 2004;107(Pt 2):1434-7
15361052
AIDS. 2002 May 3;16(7):1051-8
11953472
J Acquir Immune Defic Syndr. 2004 Aug 15;36(5):1100-2
15247564
AIDS. 2001 Jun 15;15(9):1181-3
11416722
AIDS. 2007 May 11;21(8):965-71
17457090
AIDS Behav. 2006 May;10(3):227-45
16783535
Health Serv Res. 2005 Jun;40(3):849-64
15960694
PLoS Med. 2008 May 20;5(5):e109
18494555
Ann Intern Med. 2010 Jan 5;152(1):54-6; W-13
20048272
Ann Pharmacother. 2001 Sep;35(9):1010-5
11573846
J Acquir Immune Defic Syndr. 2006 Mar;41(3):285-97
16540929