Individualized Texting for Adherence Building (iTAB): Improving Antiretroviral Dose Timing Among HIV-Infected Persons with Co-occurring Bipolar Disorder

Abstract

HIV+ persons with co-occurring bipolar disorder (HIV+/BD+) have elevated rates of medication nonadherence. We conducted a 30-day randomized controlled trial of a two-way, text messaging system, iTAB (n = 25), compared to an active comparison (CTRL) (n = 25) to improve antiretroviral (ARV) and psychotropic (PSY) adherence and dose timing. Both groups received medication adherence psychoeducation and daily texts assessing mood. The iTAB group additionally received personalized medication reminder texts. Participants responded to over 90 % of the mood and adherence text messages. Mean adherence, as assessed via electronic monitoring caps, was high and comparable between groups for both ARV (iTAB 86.2 % vs. CTRL 84.8 %; p = 0.95, Cliff’s d = 0.01) and PSY (iTAB 78.9 % vs. CTRL 77.3 %; p = 0.43, Cliff’s d = −0.13) medications. However, iTAB participants took ARVs significantly closer to their intended dosing time than CTRL participants (iTAB: 27.8 vs. CTRL: 77.0 min from target time; p = 0.02, Cliff’s d = 0.37). There was no group difference on PSY dose timing. Text messaging interventions may represent a low-burden approach to improving timeliness of medication-taking behaviors among difficult-to-treat populations. The benefits of improved dose timing for long-term medication adherence require additional investigation.

A Rapid Review of eHealth Interventions Addressing the Continuum of HIV Care (2007–2017)

“…Most of the theory-driven eHealth interventions (k = 19) were efficacious (74%, k = 14) for improving only medication adherence [32, 33, 35, 37, 38]; both medication adherence and virologic suppression [29, 30]; or care retention [26, 31]. Half (k = 7) of these efficacious, theory-based eHealth interventions were US-based [32] [33] [24, 30, 31, 34, 35].…”

“…The theoretically-driven international-based interventions (k = 5) primarily used non-interactive (i.e., one-way communication) eHealth technology using either SMS texting [36] or electronic pill reminder alarm device [26, 37]. A few theory-driven interventions (k = 3) did not report the country setting in the report [38] [39, 40]. We located five theory-driven eHealth interventions [25, 36, 37, 41, 42] that showed no evidence for improving any health outcomes related to the CoC.…”

“…One study [58] described an SMS-based intervention comprised of four specific text messages that increased ART adherence among PLWH living in Kenya. Another study [38] also identified that an individualized SMS texting intervention improved dose timing among PLWH with co-occurring bipolar disorders. An additional study [19] found preliminary evidence of efficacy for a SMS-based intervention improving medication adherence (as well as retention in care) among youth and young adults.…”

“…Most of the efficacious SMS-based interventions (e.g., [38, 51, 53, 59, 60]) have a bidirectional component whether via the electronic device or augmented by other modalities (e.g., face-to-face counseling) that facilitate a more interactive experience between client and provider. We also found few studies (k = 3) that used SMS texting to increase retention of PLWH in HIV care.…”

“…We found that these interactions are often facilitated with SMS texting. Some of these interactions are facilitated either solely with SMS texting [38, 47, 51, 53, 59] or augmented with in-person counseling [19, 60]. Based on this finding, eHealth interventions may contribute to enhancing individual-level interactions by reducing the burden of clients using resources related to travel and information access that can impede these interactions.…”