title: Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy.
abstract: Adherence to antiretroviral therapy (ART) represents one of the strongest predictors of progression to AIDS, yet it is difficult for most patients to sustain high levels of adherence. This study compares the efficacy of a personalized cell phone reminder system (ARemind) in enhancing adherence to ART versus a beeper. Twenty-three HIV-infected subjects on ART with self-reported adherence less than 85% were randomized to a cellular phone (CP) or beeper (BP). CP subjects received personalized text messages daily; in contrast, BP subjects received a reminder beep at the time of dosing. Interviews were scheduled at weeks 3 and 6. Adherence to ART was measured by self-report (SR, 7-day recall), pill count (PC, past 30 days at baseline, then past 3 weeks), Medication Event Monitoring System (MEMS; cumulatively at 3 and 6 weeks), and via a composite adherence score constructed by combining MEMS, pill count, and self report. A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks. Nineteen subjects completed all visits, 10 men and 9 females. The mean age was 42.7 ± 6.5 years, 37% of subjects were Caucasian and 89% acquired HIV heterosexually. The average adherence to ART was 79% by SR and 65% by PC at baseline in both arms; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence. A larger and longer prospective study is needed to confirm these findings and to better understand optimal reminder messages and user fatigue.
authors.affiliation: Center for HIV/AIDS Care and Research, Boston University Medical Center, Massachusetts, USA. hhardy34@gmail.com
authors.forename: Helene
authors.initials: H
authors.lastname: Hardy
authors.forename: Vikram
authors.initials: V
authors.lastname: Kumar
authors.forename: Gheorghe
authors.initials: G
authors.lastname: Doros
authors.forename: Eric
authors.initials: E
authors.lastname: Farmer
authors.forename: Mari-Lynn
authors.initials: ML
authors.lastname: Drainoni
authors.forename: Denis
authors.initials: D
authors.lastname: Rybin
authors.forename: Dan
authors.initials: D
authors.lastname: Myung
authors.forename: Jonathan
authors.initials: J
authors.lastname: Jackson
authors.forename: Elke
authors.initials: E
authors.lastname: Backman
authors.forename: Anela
authors.initials: A
authors.lastname: Stanic
authors.forename: Paul R
authors.initials: PR
authors.lastname: Skolnik
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D040421:Cell Phone; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010358:Patient Participation
chemical_list: D019380:Anti-HIV Agents