title: Improving Adherence to Antiretroviral Therapy With Triggered Real-time Text Message Reminders: The China Adherence Through Technology Study.
abstract: BACKGROUND
  Real-time adherence monitoring is now possible through medication storage devices equipped with cellular technology. We assessed the effect of triggered cell phone reminders and counseling using objective adherence data on antiretroviral therapy (ART) adherence among Chinese HIV-infected patients.
  
  
  METHODS
  We provided ART patients in Nanning, China, with a medication device (Wisepill) to monitor their ART adherence electronically. After 3 months, we randomized subjects within optimal (≥95%) and suboptimal (<95%) adherence strata to intervention vs. control arms. In months 4-9, intervention subjects received individualized reminders triggered by late dose taking (no device opening by 30 minutes past dose time) and counseling using device-generated data. Controls received no reminders or data-informed counseling. We compared postintervention proportions achieving optimal adherence, mean adherence, and clinical outcomes.
  
  
  RESULTS
  Of 120 subjects enrolled, 116 (96.7%) completed the trial. Preintervention optimal adherence was similar in intervention vs. control arms (63.5% vs. 58.9%, respectively; P = 0.60). In the last intervention month, 87.3% vs. 51.8% achieved optimal adherence [risk ratio (RR): 1.7, 95% confidence interval (CI): 1.3 to 2.2] and mean adherence was 96.2% vs. 89.1% (P = 0.003). Among preintervention suboptimal adherers, 78.3% vs. 33.3% (RR: 2.4, CI: 1.2 to 4.5) achieved optimal adherence and mean adherence was 93.3% vs. 84.7% (P = 0.039). Proportions were 92.5% and 62.9% among optimal adherers, respectively (RR: 1.5, CI: 1.1 to 1.9) and mean adherence was 97.8% vs. 91.7% (P = 0.028). Postintervention clinical outcomes were not significant.
  
  
  CONCLUSIONS
  Real-time reminders significantly improved ART adherence in this population. This approach seems promising for managing HIV and other chronic diseases and warrants further investigation and adaptation in other settings.
authors.affiliation: *Center for Global Health and Development, Boston University, Boston, MA; †Department of Global Health, Boston University School of Public Health, Boston, MA; ‡FHI 360, Beijing, China; §Research Center for Public Health (TPHRC), School of Medicine, Tsinghua University, Beijing, China; ‖WHO Collaborating Center for Comprehensive Management of HIV Treatment and Care, Ditan Hospital, Beijing, China; ¶AIDS Division, Guangxi Centers for Disease Control and Prevention, Nanning, China; #Center for Global Health, Massachusetts General Hospital, Boston, MA; **Department of Health Policy and Management, Boston University School of Public Health, Boston, MA; and ††Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.
authors.forename: Lora L
authors.initials: LL
authors.lastname: Sabin
authors.forename: Mary
authors.initials: M
authors.lastname: Bachman DeSilva
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Gill
authors.forename: Li
authors.initials: L
authors.lastname: Zhong
authors.forename: Taryn
authors.initials: T
authors.lastname: Vian
authors.forename: Wubin
authors.initials: W
authors.lastname: Xie
authors.forename: Feng
authors.initials: F
authors.lastname: Cheng
authors.forename: Keyi
authors.initials: K
authors.lastname: Xu
authors.forename: Guanghua
authors.initials: G
authors.lastname: Lan
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Haberer
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
authors.forename: Yongzhen
authors.initials: Y
authors.lastname: Li
authors.forename: Hongyan
authors.initials: H
authors.lastname: Lu
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002681:China; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D060145:Text Messaging
chemical_list: D019380:Anti-HIV Agents