HIV adherence strategies take a high-tech route
HIV adherence strategies take a high-tech route
Electronic gadget gives verbal messages
An investigational HIV-adherence device has demonstrated that it can keep patients on track with their antiretroviral therapy more effectively than a monthly educational session, according to a recent study. The pocket-sized electronic device, called the Disease Management Assistance System (DMAS), tells patients when to take various medications and what side effects to monitor.
"One of the main reasons patients say they do not take their medication is because they simply forget it," says Adriana Andrade, MD, MPH, senior clinical pharmacology fellow at Johns Hopkins University School of Medicine in Baltimore. Andrade was a chief investigator in a study involving the device. Results of the ongoing study were presented at the 8th Conference on Retroviruses and Opportunistic Infections, held Feb. 4-8, 2001, in Chicago.
The DMAS emits a beeping sound when patients are supposed to take their medication. The beeping prompts patients to press a "play" button on the DMAS. Then the device will play a verbal medication reminder. Once patients take their medication and press a "yes" button, the device will record the dosing time. The recorded data can be uploaded to generate an adherence report for clinicians to review, Andrade explains.
Johns Hopkins investigators studied the device, putting 50 patients randomly in one of two groups. The intervention group received the DMAS plus monthly antiretroviral education and counseling, and the control group only received the education and counseling. All participants were given eDEM Caps, a special medication cap with a microcomputer chip that noted the times and dates when patients opened the bottle to take medications, Andrade explains. The eDEM Caps were used to validate the data obtained from the DMAS. Subjects were followed for six months.
Patients’ viral loads and spinal fluid were tested at baseline, prior to antiretroviral initiation, and at three months and six months after starting treatment. Memory testing was performed at baseline and at the end of the study to check the impact of HIV-mediated memory deficits on medication adherence.
The study examined patients who were starting highly active antiretroviral therapy for the first time or who had failed it once or twice in the past. "We wanted a representation of naive and experienced patients to see whether this device would affect medication adherence the same way in the two groups," Andrade says.
The study’s target is 86 subjects, and 52 were enrolled through June 2001. A preliminary data analysis of the first 19 patients who completed the study showed that the overall mean adherence score for the intervention group was 92%, as compared to 83% for the control group, Andrade says.
Data analysis also showed that memory-impaired subjects assigned to the DMAS group reached mean adherence scores of 90%, compared to 80% in the control arm. "So it seems, as we suspected, that neurocognitive deficits do affect adherence to antiretroviral therapy," Andrade says. "Also, it seems the device does make a difference, even in a setting of mild or moderate neurocognitive impairment."
Patients’ viral loads in both plasma and spinal fluid showed a 1.5 log decrease for patients who used the device, whereas there was only a 0.5 log decrease among the control group, Andrade says. "This change was statistically significant. When we looked at the CD4 cell count, the DMAS users over six months had increased their count by a mean increase of 50 CD4 cells, and the control group had an increase of 10 CD4 cells," Andrade adds.
The study, which is ongoing, shows that the DMAS device holds promise for clinicians who are dealing with HIV patients who have memory deficits. The device also may improve adherence among other HIV patients who might be at higher risk of forgetting to take their medications. The device currently is available only through investigational trials. "We are trying desperately to come up with novel ways to address the adherence issue and improve that," Andrade says. "Electronic devices might be another way to improve compliance to antiretroviral therapies."
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.