Randomized controlled trial of a personalized cellular phone reminder system to enhance adherence to antiretroviral therapy

Abstract

Adherence to antiretroviral therapy (ART) represents one of the strongest predictors of progression to AIDS, yet it is difficult for most patients to sustain high levels of adherence. This study compares the efficacy of a personalized cell phone reminder system (ARemind) in enhancing adherence to ART versus a beeper. Twenty-three HIV-infected subjects on ART with self-reported adherence less than 85% were randomized to a cellular phone (CP) or beeper (BP). CP subjects received personalized text messages daily; in contrast, BP subjects received a reminder beep at the time of dosing. Interviews were scheduled at weeks 3 and 6. Adherence to ART was measured by self-report (SR, 7-day recall), pill count (PC, past 30 days at baseline, then past 3 weeks), Medication Event Monitoring System (MEMS; cumulatively at 3 and 6 weeks), and via a composite adherence score constructed by combining MEMS, pill count, and self report. A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks. Nineteen subjects completed all visits, 10 men and 9 females. The mean age was 42.7 ± 6.5 years, 37% of subjects were Caucasian and 89% acquired HIV heterosexually. The average adherence to ART was 79% by SR and 65% by PC at baseline in both arms; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence. A larger and longer prospective study is needed to confirm these findings and to better understand optimal reminder messages and user fatigue.

FIG. 1.

Overview of ARemind 1 System. To begin, a caregiver registers a patient's mobile number, content preference, and dosing schedule in the system (1). At the scheduled time, the scheduler pulls fresh content from third party content providers (2), then generates a text message which is sent to the patient (3). The patient responds to the text message indicating that they have taken their medication (4).

FIG. 2.

Composite adherence score (CAS) over time by intervention group. Closed circle: Adjusted composite adherence score (%) for subjects randomized to the beeper arm. Open circle: Adjusted composite adherence score (%) for subjects randomized to the cellular phone arm. Closed square: Baseline adjusted adherence rate calculated via pill count; d: difference in composite adherence score between the beeper arm and cellular phone arm.