Text message reminders did not improve ART adherence
SEATTLE — While mobile phone text message reminders tracked by real-time adherence monitoring did reduce the number of treatment interruptions lasting longer than 72 hours, they do not appear to improve patient adherence or HIV viral suppression, according to findings presented here at CROI 2015.
“The benefits of technology in supporting adherence, while widely promoted, may be more nuanced than we realized and that data is the field remains limited,” Catherine Orrell, MBChB, MMed, MSc, associate professor at the Desmond Tutu HIV Centre, University of Cape Town, South Africa, told Infectious Disease News.
Orrell and colleagues evaluated 230 HIV patients undergoing treatment at an outpatient ART clinic in South Africa who had not previously received treatment. Patients were randomly assigned to standard of care (SoC), which entailed three pretreatment group education sessions (n=115), or intervention, which consisted of SoC plus an automated text message reminder (n=115). The reminder was sent to the patient’s mobile phone if dosing was determined by an electronic adherence monitoring device (EAMD) to be more than 30 minutes late. Neither staff nor participants were blinded to study group. EAMDs were given to all study participants at the initiation of ART, with follow-ups continued for 48 weeks.
The researchers collected blood for CD4 counts and viral load at baseline, week 16 and week 48. The study outcomes were defined as the proportion of doses taken over the time as chronicled by EAMD, and plasma HIV-1 viral load suppression (< 40 copies/mL) at week 48. Missing a follow up was considered to be a negative outcome.
The researchers found that the intervention arm achieved a median adherence by EAMD of 82.1% (interquartile range [IQR], 56.6%-94.6%), while the SoC arm had a median adherence of 80.4% (IQR, 52.8%-93.8%), resulting in an adjusted OR for adherence of 1.08 (95% CI, 0.77-1.52). Viral load suppression was observed in 80 (69.6%) of SoC and 75 (65.2%) of intervention patients (aOR = 0.77; 95% CI, 0.42-1.40) at week 48. In the intervention arm, the count of treatment interruptions lasting longer than 72 hours was reduced 16% (aIRR = 0.84, 95% CI 0.75-0.94). Median duration of treatment interruptions was 8 days (IQR 5-15 days).
“Our study showed that text message reminders linked to late doses detected by real-time adherence monitoring significantly reduced the frequency of treatment interruptions lasting longer than 72 hours, but had no effect on overall adherence execution, or HIV RNA suppression,” the researchers wrote. “Treatment interruptions greater than 72 hours have been shown to be a significant cause of virologic failure and acquisition of drug resistance. Future studies are needed to determine best timing of the reminders and whether the level of adherence support supplied by electronic monitoring can replace intensive counselling linked with home visits in this population.” – by Jen Byrne
Reference: Orrell C. et al. Abstract 559. Presented at: Conference on Retroviruses and Opportunistic Infections. Feb. 23-26; Seattle.
Disclosure: Orrell reports no relevant disclosures.