Real-Time Adherence Monitoring for HIV Antiretroviral Therapy

Abstract

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.

Food Insufficiency and Medication Adherence Among People Living with HIV/AIDS in Urban and Peri-Urban Settings

“…The cost of providing cell phones with limited and restricted service can be offset by reducing the medical and societal expenses that come with ART non-adherence including diminished health, hospitalizations, and drug resistant virus (Bangsberg and Deeks 2010). Emerging technologies for improving medication adherence are also bringing new opportunities for people in rural areas, including real-time medication monitoring and electronic reminder systems (Haberer et al 2010). Additional efforts to remove geographical barriers to maintaining long-term ART adherence are therefore needed to ameliorate health disparities between persons living inside and outside urban centers.…”

Feasibility and Acceptability of Digital Gaming to Improve Adherence among Adolescents and Young Adults Living with HIV (Preprint)

“…The feasibility and acceptability of using wireless electronic device monitoring adherence among HIVinfected persons has been demonstrated in other settings including in China and Uganda. In Uganda, adult HIV-infected patients described the Wisepill device easy to use and convenient, and it was found to be non-inferior to the Medication Event Monitoring System (MEMS) pill bottle caps [15]. Further, among Chinese children ages 10-15 years, the Wisepill dispensers were reported to be an acceptable and rigorous method of evaluating ART adherence, and were found to be potentially useful for adherence support among adolescents living with HIV [39].…”

“…Current approaches to ART adherence monitoring and support include text messaging, self-reporting, pill counts, pharmacy refill assessments, and electronic monitoring with devices such as Wisepill, a portable medication dispenser that emits a wireless signal when opened, used for monitoring real-time adherence [15][16][17][18][19][20][21][22][23][24]. While a few studies have provided evidence of the feasibility, acceptability, and performance of electronic monitoring of ART adherence, use of the Wisepill dispenser for real-time adherence monitoring is currently understudied and appears to be a promising adherence strategy to explore.…”

Ethical Questions in Medical Electronic Adherence Monitoring

“…21 The extent to which someone tolerates loss of privacy or confidentiality is culturally and individually relative. 22 For instance, while HIV patients in India and Malawi 23 and in the United States 24 have expressed concerns that electronic pill bottles could raise suspicion from family and neighbors, such concerns were not raised by HIV patients in Uganda, 5 Tanzania, 10 or South Africa. 25 The heterogeneous findings of these studies may reflect variations in individual or cultural conceptualization of privacy and confidentiality, in criteria for what counts as a breach, or differences in disease-associated stigma.…”

“…Some devices report adherence in real time, allowing researchers to investigate adherence problems as they occur. 5 EAMs are utilized primarily in research settings, although use in clinical care is increasing.…”