HIV pill reminder device shows some adherence improvement
Technology now switched to cell phone
Researchers studying a population of HIV patients found that a pill reminder improved adherence for those who were memory impaired.1
"One reason patients don’t take medications is because they simply forget it, and it’s more of an issue in the population we studied because some started with mild cognitive impairment," says Adriana Andrade, MD, MPH, an assistant professor at Johns Hopkins University Division of Infectious Diseases in Baltimore, MD.
"So a device that prompts your memory and tells you what to take and when to take it might over come some normal memory impairment that comes with this disease," Andrade says. "I think these findings raise a very important point, maybe not just for HIV-infected population, but for the elderly population as well."
Investigators used a Disease Management Assistance System (DMAS) device developed by Adherence Technologies Corp. of Dulles, VA. The device was battery-powered with a digital signal processor to produce a timed, programmed voice message. It also records data about when medication was taken after the person using it presses a response button.1
The study measured antiretroviral drug adherence using electronic drug-exposure monitoring (eDEM) caps.1
At 24 weeks in the study, the HIV patients with mild memory impairment who used the DMAS device had a significantly higher adherence rate than did memory-impaired subjects who did not use the device, with 79 percent adherence versus 56 percent adherence among the control group.1
Although the HIV patients without memory impairment also tended to have greater adherence in the DMAS device group, when compared to a control group, these differences were not significant, Andrade says.
Subjects with mild memory impairment were not HIV patients with dementia, but were those who were able to go about their daily routine and take medications on their own, Andrade explains.
"The only way to find out if they had memory impairment was to do psychological testing like I did," Andrade says. "So what we found was that among the patients who got the device, the memory-impaired subjects were the ones who benefited the most from the device."
The adherence percentages didn’t raise for any group to the high levels of adherence that researchers say is necessary to obtain optimal suppression of the virus, Andrade notes.
"The point is that there might be a subset of HIV-infected patients with mild memory impairment where this high cutoff might be unachievable," Andrade suggests. "Or in order to be achieved we will have to use much more frequent monitoring and come up with ways to help these patients take their medication and improve their compliance."
The DMAS device was small and rectangular with a "play" button and "yes" key and "advice" button.
"Patients had the option to carry it in a pocket or camera case or fanny pack," Andrade says.
When the device beeps and the light on the play button blinks, the patient could press the "play" button to acknowledge the beep and to hear the recorded message that would tell the patient to take this particular medication in this dosage, Andrade says.
Then when the patient took the medication, he or she could press the "yes" button, which would record the time and date of their taking the medication. The patient also had the option of pressing the "advice" button to hear additional instructions, such as, "Take one tablet on an empty stomach," Andrade explains.
To assuage privacy concerns, the process was set up so that the verbal message did not come on unless the patient pressed "play." This way the patient could take the device to a private area before hearing the reminder, Andrade says.
Interestingly, the company that made the device has abandoned that design and has created a cell phone reminder tool instead, which is being sold as a service for pharmacies, Andrade says.
Patients enrolled in the study were on a variety of antiretroviral regimens for a total of no more than three different regimens, Andrade says.
"We looked at very experienced in terms of exposure and at antiretroviral-naïve patients," Andrade says. "We wanted a representative sample for the study."
The main lesson from the study is that adherence interventions need to be individualized since not every approach helps each person the same way, Andrade says.
Also, as patients infected with HIV age, the prevalence of mild forms of cognitive impairment might be increasing, Andrade says.
"For this population, the message is that caregivers must be aware of the negative impact that even a mild cognitive impairment can have on HIV therapy," Andrade says. "So providers should be aware of that and explore other adherence aids that can help this patient population with antiretroviral medication."
Reference
- Andrade AS, et al. A Programmable Prompting Device Improves Adherence to Highly Active Antiretroviral Therapy in HIV-Infected Subjects With Memory Impairment. Clin Infect Dis. 2005;41(15):875-882.
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