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Review
. 2020 Aug;17(4):301-314.
doi: 10.1007/s11904-020-00502-5.

Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions

Matthew A Spinelli  1 , Jessica E Haberer  2 , Peter R Chai  3 , Jose Castillo-Mancilla  4 , Peter L Anderson  5 , Monica Gandhi  6   7
Affiliations
Review

Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions

Matthew A Spinelli et al. Curr HIV/AIDS Rep. 2020 Aug.

Abstract

Purpose of review: Traditional methods to assess antiretroviral adherence, such as self-report, pill counts, and pharmacy refill data, may be inaccurate in determining actual pill-taking to both antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP). HIV viral loads serve as surrogates of adherence on ART, but loss of virologic control may occur well after decreases in adherence and viral loads are not relevant to PrEP.

Recent findings: Pharmacologic measures of adherence, electronic adherence monitors, and ingestible electronic pills all serve as more objective metrics of adherence, surpassing self-report in predicting outcomes. Pharmacologic metrics can identify either recent adherence or cumulative adherence. Recent dosing measures include antiretroviral levels in plasma or urine, as well as emtricitabine-triphosphate in dried blood spots (DBS) for those on tenofovir-emtricitabine-based therapy. A urine tenofovir test has recently been developed into a point-of-care test for bedside adherence monitoring. Cumulative adherence metrics assess adherence over weeks to months and include measurement of tenofovir-diphosphate in peripheral blood mononuclear cells or DBS, as well as ART levels in hair. Electronic adherence monitors and ingestible electronic pills can track pill bottle openings or medication ingestion, respectively. New and objective approaches in adherence monitoring can be used to detect nonadherence prior to loss of prevention efficacy or virologic control with PrEP or ART, respectively.

Keywords: ART; Adherence metrics; Electronic adherence monitors; Ingestible sensors; Pharmacologic metrics; PrEP.

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Conflict of interest statement

Conflicts of interest: M.A.S., P.R.C., J.C.M., and M.G. have no relevant conflicts of interest to report. P.L.A. has received grant funding from Gilead. J.E.H. has accepted consulting funds from Merck Pharmaceuticals.

Figures

Figure 1:
Figure 1:. Time Frames Examined by Pharmacologic Measures of Adherence
Figure 2:
Figure 2:. Clinical Interpretation of Paired HIV Viral Load and Objective Adherence Data for ART
Figure 3:
Figure 3:. Prototype for first lateral flow assay for tenofovir detection in urine
See this image and copyright information in PMC

References

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