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Msosa TC, Swai I, Aarnoutse R, Rinke de Wit TF, Ngowi K, Msefula C, Nliwasa M, Boer MSD. The Effect of Real-Time Medication Monitoring-Based Digital Adherence Tools on Adherence to Antiretroviral Therapy and Viral Suppression in People Living With HIV: A Systematic Literature Review and Meta-Analysis. J Acquir Immune Defic Syndr 2024; 96:411-420. [PMID: 38985562 PMCID: PMC11236270 DOI: 10.1097/qai.0000000000003449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/19/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Universal antiretroviral therapy (ART) has led to improved treatment outcomes in persons living with HIV. Adherence to ART is required to achieve viral suppression. Real-time medication monitoring (RTMM)-based digital adherence tools (DATs) could be effective in improving ART adherence and viral suppression in persons living with HIV. OBJECTIVES The primary and secondary objectives of this review were to assess the effect of RTMM-based DATs on improving ART adherence and viral load suppression. METHODS We searched MEDLINE, Embase, and Global Health for publications published through October 11, 2022. Narrative synthesis and random effects meta-analyses were conducted to synthesize the results. RESULTS Of 638 papers identified, 8 were included. Six studies were randomized controlled trials (RCTs), and 2 were cohort studies. Two studies, an RCT in China (mean adherence: 96.2% vs 89.1%) and a crossover cohort study in Uganda (mean adherence: 84% vs 93%), demonstrated improved ART adherence. No studies demonstrated improved viral suppression. In the meta-analyses, we estimated that RTMM-based digital adherence tools had a statistically insignificant small positive effect on ART adherence and viral suppression with a standardized mean difference of 0.1922 [95% CI: -0.0268 to 0.4112, P-value: 0.0854] and viral suppression with an odds ratio of 1.3148 [95% CI: 0.9199 to 1.8791, P-value: 0.1331]. CONCLUSIONS Our meta-analyses found that RTMM-based DATs did not have a significant effect on ART adherence and viral suppression. However, due to few published studies available, heterogeneity of target populations, intervention designs, and adherence measurement instruments, more data are required to provide conclusive evidence.
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Affiliation(s)
- Takondwa Charles Msosa
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Iraseni Swai
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Rob Aarnoutse
- Radboud University Medical Center, Department of Pharmacy, Research Institute for Medical Innovation, Nijmegen, the Netherlands; and
| | - Tobias F. Rinke de Wit
- Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Chisomo Msefula
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Marriott Nliwasa
- Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Marion Sumari-de Boer
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
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Ogello VA, Rono BK, Ngure K, Sedah E, Thuo NB, Musinguzi N, Baeten JM, Bukusi EA, Mugo NR, Haberer JE. Acceptability and feasibility of long-term, real-time electronic adherence monitoring of HIV pre-exposure prophylaxis (PrEP) use among young women in Kenya: A mixed methods study. PLoS One 2024; 19:e0299168. [PMID: 38451884 PMCID: PMC10919630 DOI: 10.1371/journal.pone.0299168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/05/2024] [Indexed: 03/09/2024] Open
Abstract
Real-time electronic adherence monitoring involves "smart" pill boxes that record and monitor openings as a proxy for pill taking and may be useful in understanding and supporting PrEP use; however, acceptability and/or feasibility for PrEP users is uncertain. We sought to understand the experiences of using a real-time electronic adherence monitor for PrEP delivery among young women in Kisumu and Thika, Kenya. We used the Wisepill device to monitor PrEP use among 18-24-year-old women for two years. Half of the participants were randomized to also receive SMS adherence reminders (daily or as needed for missed doses). We assessed acceptability quantitatively and qualitatively according to the four constructs of Unified Theory of Acceptance and Use of Technology (UTAUT): performance expectancy, effort expectancy, social influence, and facilitating conditions. We assessed feasibility by monitor functionality during periods of PrEP use. We analyzed quantitative data descriptively and compared by site and over time; qualitative data were analyzed inductively and deductively. The median age was 21 years (IQR 19-22), median education was 12 years (IQR 10-13), 182 (53%) had disclosed PrEP use, and 55 (16%) reported recent intimate partner violence. Most participants reported high levels of usefulness and high interest in using the monitor with few problems or worries reported throughout follow-up. Feasibility was high overall with some differences by site (96% functional monitor days in Kisumu vs 88% in Thika). Few monitors were reported lost (N = 29; 8%) or dysfunctional (N = 11; 3%). In qualitative interviews, electronic monitoring was perceived as useful because it supported privacy, confidentiality, easy storage, and PrEP adherence. Effort was generally considered low. Participants expressed some concern for stigma from monitor and/or PrEP use. Facilitating conditions involved the monitor size, color, and battery life. Overall, real-time electronic adherence monitoring was a highly acceptable and feasible approach to understand PrEP adherence among young women in a sub-Saharan African setting.
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Affiliation(s)
- Vallery A. Ogello
- Center of Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Eric Sedah
- Center for microbiology research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Nicholas B. Thuo
- Center of Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Gilead Sciences, Foster City, California, United States of America
| | - Elizabeth A. Bukusi
- Center for microbiology research, Kenya Medical Research Institute, Kisumu, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Nelly R. Mugo
- Center of Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Jessica E. Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Anenmose Maro R, Mtenga A, Mtesha B, Wilhelm K, Lekashingo N, Sumari-de Boer M, Ngowi K. Implementation bottlenecks of real time medication monitoring (evriMED) for improving adherence to anti-TB drugs among people with tuberculosis in Kilimanjaro, Tanzania. J Clin Tuberc Other Mycobact Dis 2024; 34:100409. [PMID: 38225942 PMCID: PMC10788294 DOI: 10.1016/j.jctube.2023.100409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Introduction Digital Adherence Tools (DATs), which include real-time medication monitoring and Short Message Service (SMS) reminders, have been reported to improve medication adherence among people with Tuberculosis (TB). Recently, in limited resource settings, DATs have been described as a promising tool to monitor patients' medication behaviour. We aimed to determine implementation bottlenecks of real-time medication monitoring using the evriMED device. Method We conducted a research study using a mixed-methods approach, involving both people with TB s and directly observed treatment (DOT) providers who participated in the REMIND-TB trial and utilized the evriMED devices. EvriMED is a medication dispenser with internet connectivity that can send real-time SMS reminders. To gather data, we extracted reports from the Wisepill dashboard, specifically the client status report. This report documented the activity status of all devices, including communication and battery status. Additionally, we conducted in-depth interviews with people with TB and TB care providers who were involved in implementing the Remind TB trial in the Kilimanjaro region. These interviews were guided by the MIDI (Measurement Instrument for Determinants of Innovation), which helps identify the factors influencing the implementation of innovations such as evriMED. Results Out of the initial 281 participants who were given devices, 245 completed the 6-month follow-up period. The findings indicate that at month 6, most of the devices (49%) reported battery-related challenges. Additionally, forty devices (14%) had reported more than one incidence of losing communication. Through interviews with participants, we observed that evriMED was perceived as user-friendly, and the people with TB reported high satisfaction as the device facilitated improved medication intake. TB care providers also said that evriMED was a relevant tool to be used by the people with TB. However, during the in-depth interview certain implementation bottlenecks were identified, including network issues, limited training, and low technology knowledge among TB care providers, who found the procedure of using the evriMED to be time-consuming. Conclusion Implementation of evriMED was perceived as user-friendly and highly satisfactory by people with TB. Certain implementation bottlenecks were identified as potential barriers to the use of devices. These bottlenecks include network issues, limited training, battery-related challenges and low technological knowledge among TB care providers, which may have contributed to communication loss. Further research may be needed to address these limitations and develop effective strategies to facilitate the successful implementation of evriMED as a tool for improving medication intake among people with TB.
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Affiliation(s)
- Rehema Anenmose Maro
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Alan Mtenga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Benson Mtesha
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | | | | | - Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Kilimanjaro Christian Medical Univesity Collage, Moshi, Tanzania
- Knowledge, Innovation & Technology Group at Wageningen & University Research, the Netherlands
| | - Kennedy Ngowi
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
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Jennings L, West RL, Halim N, Kaiser JL, Gwadz M, MacLeod WB, Gifford AL, Haberer JE, Orrell C, Sabin LL. Protocol for an evaluation of adherence monitoring and support interventions among people initiating antiretroviral therapy in Cape Town, South Africa-a multiphase optimization strategy (MOST) approach using a fractional factorial design. Trials 2023; 24:310. [PMID: 37147725 PMCID: PMC10163747 DOI: 10.1186/s13063-023-07322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND South Africa bears a large HIV burden with 7.8 million people with HIV (PWH). However, due to suboptimal antiretroviral therapy (ART) adherence and retention in care, only 66% of PWH in South Africa are virally suppressed. Standard care only allows for suboptimal adherence detection when routine testing indicates unsuppressed virus. Several adherence interventions are known to improve HIV outcomes, yet few are implemented in routinely due to the resources required. Therefore, determining scalable evidence-based adherence support interventions for resource-limited settings (RLS) is a priority. The multiphase optimization strategy (MOST) framework allows for simultaneous evaluation of multiple intervention components and their interactions. We propose to use MOST to identify the intervention combination with the highest levels of efficacy and cost-effectiveness that is feasible and acceptable in primary care clinics in Cape Town. METHODS We will employ a fractional factorial design to identify the most promising intervention components for inclusion in a multi-component intervention package to be tested in a future randomized controlled trial. We will recruit 512 participants initiating ART between March 2022 and February 2024 in three Cape Town clinics and evaluate acceptability, feasibility, and cost-effectiveness of intervention combinations. Participants will be randomized to one of 16 conditions with different combinations of three adherence monitoring components: rapid outreach following (1) unsuppressed virus, (2) missed pharmacy refill collection, and/or (3) missed doses as detected by an electronic adherence monitoring device; and two adherence support components: (1) weekly check-in texts and (2) enhanced peer support. We will assess viral suppression (<50 copies/mL) at 24 months as the primary outcome; acceptability, feasibility, fidelity, and other implementation outcomes; and cost-effectiveness. We will use logistic regression models to estimate intervention effects with an intention-to-treat approach, employ descriptive statistics to assess implementation outcomes, and determine an optimal intervention package. DISCUSSION To our knowledge, ours will be the first study to use the MOST framework to determine the most effective combination of HIV adherence monitoring and support intervention components for implementation in clinics in a RLS. Our findings will provide direction for pragmatic, ongoing adherence support that will be key to ending the HIV epidemic. TRIAL REGISTRATION ClinicalTrials.gov NCT05040841. Registered on 10 September 2021.
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Affiliation(s)
- Lauren Jennings
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Rebecca L West
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jeanette L Kaiser
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | - William B MacLeod
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Allen L Gifford
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, 72 E Concord Street, Boston, MA, 02118, USA
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA
- Department of Health Policy and Management, Boston University School of Public Health, Talbot Building, T348W, Boston, MA, 02118, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Catherine Orrell
- Desmond Tutu Health Foundation, Institute of Infectious Diseases and Molecular Medicine and the Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
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Jiao K, Wang C, Liao M, Ma J, Kang D, Tang W, Tucker JD, Ma W. A differentiated digital intervention to improve antiretroviral therapy adherence among men who have sex with men living with HIV in China: a randomized controlled trial. BMC Med 2022; 20:341. [PMID: 36210434 PMCID: PMC9549628 DOI: 10.1186/s12916-022-02538-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 08/23/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) adherence is still suboptimal among some key populations, highlighting the need for innovative tailored strategies. This randomized controlled trial (RCT) aimed to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men (MSM) living with HIV in China. METHODS The two-armed parallel RCT was conducted at one HIV clinic in Jinan of China from October 19, 2020, to June 31, 2021. Men were referred by health providers to join the study and then choose one of three digital strategies-text message, only instant message, or instant message plus social media. They were assigned in a 1:1 ratio to the intervention arm or control arm using block randomization, and inside each arm, there were three groups depending on the type of delivering the message. The groups were divided according to participants' preferred digital strategies. The intervention arm received ART medication messages, medication reminders, peer education, and involved in online discussion. The control arm received messages on health behavior and nutrition. The primary outcome was self-reported optimal ART adherence, defined as not missing any doses and not having any delayed doses within a one-month period. Secondary outcomes included CD4 T cell counts, viral suppression, HIV treatment adherence self-efficacy, and quality of life. Intention-to-treat analysis with generalized linear mixed models was used to evaluate the intervention's effect. RESULTS A total of 576 participants were enrolled, including 288 participants assigned in the intervention arm and 288 assigned in the control arm. Most were ≤ 40 years old (79.9%) and initiated ART ≤ 3 years (60.4%). After intervention, the proportion of participants achieving optimal ART adherence in the intervention arm was higher than in the control arm (82.9% vs 71.1%). The differentiated digital intervention significantly improved ART adherence (RR = 1.74, 95%CI 1.21-2.50). Subgroup analysis showed one-to-one instant message-based intervention significantly improved ART adherence (RR = 2.40, 95% CI 1.39-4.17). CONCLUSIONS The differentiated digital intervention improved ART adherence among MSM living with HIV in China, which could be integrated into people living with HIV (PLWH) management and further promoted in areas where PLWH can access text messaging and instant messaging services. TRIAL REGISTRATION ChiCTR2000041282. Retrospectively registered on 23 December 2020.
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Affiliation(s)
- Kedi Jiao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Chunmei Wang
- Shandong Public Health Clinical Center, Jinan, Shandong, People's Republic of China
| | - Meizhen Liao
- Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
| | - Jing Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China
| | - Dianmin Kang
- Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China.
| | - Weiming Tang
- University of North Carolina Chapel Hill Project-China, Guangzhou, Guangdong, People's Republic of China.
| | - Joseph D Tucker
- University of North Carolina Chapel Hill Project-China, Guangzhou, Guangdong, People's Republic of China. .,Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
| | - Wei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, People's Republic of China.
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Bright EE, Genung SR, Stanton AL, Arch JJ. A mixed-methods study of the technical feasibility and patient acceptability of a real-time adherence monitor in breast cancer survivors taking adjuvant endocrine therapy. Breast Cancer Res Treat 2022; 195:393-399. [PMID: 35962148 PMCID: PMC9901531 DOI: 10.1007/s10549-022-06705-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Oral anti-cancer medications are increasingly common and endocrine therapies represent the most common oral anti-cancer medications in breast cancer. Adjuvant endocrine therapies reduce the likelihood of recurrence and mortality in the approximately 80% of women diagnosed with hormone-receptor-positive breast cancer, thus rendering adherence essential. Real-time medication adherence monitors, such as the Wisepill electronic pillbox, transmit adherence data remotely, allowing for early intervention for non-adherence. However, their feasibility and acceptability have yet to be examined among breast cancer survivors taking endocrine therapies. METHODS This study presents quantitative patient-report and technical support data and qualitative patient acceptability data on Wisepill, a common real-time adherence monitor, among 88 breast cancer survivors prescribed adjuvant endocrine therapy. RESULTS This mixed-methods study of a common real-time adherence monitor, among the first in breast cancer survivors taking adjuvant endocrine therapy, demonstrates its technical feasibility and patient acceptability. CONCLUSION The use of wireless medication monitors that transmit real-time adherence data is uniquely promising for maximizing the benefits of adjuvant endocrine therapy by allowing for continuous tracking, ongoing communication with oncologic or research teams, and early intervention. This study demonstrates the feasibility and patient acceptability of one such real-time adherence monitor.
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Affiliation(s)
- Emma E Bright
- Department of Psychology and Neuroscience, University of Colorado, Box 345, Boulder, CO, 80309-0345, USA.
| | - Sarah R Genung
- Department of Psychology and Neuroscience, University of Colorado, Box 345, Boulder, CO, 80309-0345, USA
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, CA, USA
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA, USA
- Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado, Box 345, Boulder, CO, 80309-0345, USA
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Mason M, Cho Y, Rayo J, Gong Y, Harris M, Jiang Y. Technologies for Medication Adherence Monitoring and Technology Assessment Criteria: Narrative Review. JMIR Mhealth Uhealth 2022; 10:e35157. [PMID: 35266873 PMCID: PMC8949687 DOI: 10.2196/35157] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/23/2022] [Accepted: 01/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Accurate measurement and monitoring of patient medication adherence is a global challenge because of the absence of gold standard methods for adherence measurement. Recent attention has been directed toward the adoption of technologies for medication adherence monitoring, as they provide the opportunity for continuous tracking of individual medication adherence behavior. However, current medication adherence monitoring technologies vary according to their technical features and data capture methods, leading to differences in their respective advantages and limitations. Overall, appropriate criteria to guide the assessment of medication adherence monitoring technologies for optimal adoption and use are lacking. OBJECTIVE This study aims to provide a narrative review of current medication adherence monitoring technologies and propose a set of technology assessment criteria to support technology development and adoption. METHODS A literature search was conducted on PubMed, Scopus, CINAHL, and ProQuest Technology Collection (2010-present) using the combination of keywords medication adherence, measurement technology, and monitoring technology. The selection focused on studies related to medication adherence monitoring technology and its development and use. The technological features, data capture methods, and potential advantages and limitations of the identified technology applications were extracted. Methods for using data for adherence monitoring were also identified. Common recurring elements were synthesized as potential technology assessment criteria. RESULTS Of the 3865 articles retrieved, 98 (2.54%) were included in the final review, which reported a variety of technology applications for monitoring medication adherence, including electronic pill bottles or boxes, ingestible sensors, electronic medication management systems, blister pack technology, patient self-report technology, video-based technology, and motion sensor technology. Technical features varied by technology type, with common expectations for using these technologies to accurately monitor medication adherence and increase adoption in patients' daily lives owing to their unobtrusiveness and convenience of use. Most technologies were able to provide real-time monitoring of medication-taking behaviors but relied on proxy measures of medication adherence. Successful implementation of these technologies in clinical settings has rarely been reported. In all, 28 technology assessment criteria were identified and organized into the following five categories: development information, technology features, adherence to data collection and management, feasibility and implementation, and acceptability and usability. CONCLUSIONS This narrative review summarizes the technical features, data capture methods, and various advantages and limitations of medication adherence monitoring technology reported in the literature and the proposed criteria for assessing medication adherence monitoring technologies. This collection of assessment criteria can be a useful tool to guide the development and selection of relevant technologies, facilitating the optimal adoption and effective use of technology to improve medication adherence outcomes. Future studies are needed to further validate the medication adherence monitoring technology assessment criteria and construct an appropriate technology assessment framework.
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Affiliation(s)
- Madilyn Mason
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Youmin Cho
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Jessica Rayo
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Yang Gong
- School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marcelline Harris
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI, United States
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Bartholomew T, Naci H, Robertson E, Schmidt H. Use of adherence monitoring in drug contracts tied to outcomes: put patients first. BMJ 2022; 376:e062188. [PMID: 35256379 DOI: 10.1136/bmj-2020-062188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - Huseyin Naci
- Department of Health Policy, London School of Economics, UK
| | | | - Harald Schmidt
- Department of Medical Ethics and Health Policy, University of Pennsylvania, USA
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Sabin LL, Simmons E, Halim N, Hamer DH, Gifford AL, West RL, Larson A, Bonawitz R, Aroda P, Banigbe B, Holderman AJ, Murray L, DeSilva MB, Gasuza J, Mukasa B, Messersmith LJ. Real-time Feedback to Improve HIV Treatment Adherence in Pregnant and Postpartum Women in Uganda: A Randomized Controlled Trial. AIDS Behav 2022; 26:3834-3847. [PMID: 35704124 PMCID: PMC9640413 DOI: 10.1007/s10461-022-03712-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 01/26/2023]
Abstract
We assessed an intervention aimed at improving adherence to antiretroviral therapy (ART) among pregnant and postpartum women living with HIV (PPWLH). We randomized 133 pregnant women initiating ART in Uganda to receive text reminders generated by real time-enabled electronic monitors and data-informed counseling through 3 months postpartum (PPM3) or standard care. Intention-to-treat analyses found low adherence levels and no intervention impact. Proportions achieving ≥95% adherence in PPM3 were 16.4% vs. 9.1% (t = -1.14, p = 0.26) in intervention vs. comparison groups, respectively; 30.9% vs. 29.1% achieved ≥80% adherence. Additional analyses found significant adherence declines after delivery, and no effect on disease progression (CD4-cell count, viral load), though treatment interruptions were significantly fewer in intervention participants. Per-protocol analyses encompassing participants who used adherence monitors as designed experienced better outcomes, suggesting potential benefit for some PPWLH. The study was registered on ClinicalTrials.Gov (NCT02396394).
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Affiliation(s)
- Lora L. Sabin
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
| | - Elizabeth Simmons
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA ,Carolina Population Center, University of North Carolina at Chapel Hill, 27516 Chapel Hill, NC USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
| | - Davidson H. Hamer
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA ,Department of Medicine, Boston University School of Medicine, 02118 Boston, MA USA
| | - Allen L. Gifford
- Department of Medicine, Boston University School of Medicine, 02118 Boston, MA USA ,Department of Health Law, Policy, and Management, Boston University School of Public Health, 02118 Boston, MA USA ,Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 02130 Boston, MA United States
| | - Rebecca L. West
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
| | - Anna Larson
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
| | | | - Bolanle Banigbe
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
| | - Alayna J. Holderman
- Department of Human Genetics, University of Pittsburgh School of Public Health, 15261 Pittsburgh, PA USA
| | - Lisa Murray
- Department of Epidemiology & Biostatistics, Boston University School of Public Health, 02118 Boston, MA USA
| | - Mary B. DeSilva
- Center for Excellence in Public Health, University of New England, 04103 Portland, ME USA
| | | | | | - Lisa J. Messersmith
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 3rd Floor, 02118 Boston, MA USA
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Musiimenta A, Campbell JI, Tumuhimbise W, Burns B, Atukunda EC, Eyal N, Haberer JE. Electronic Adherence Monitoring May Facilitate Intentional HIV Status Disclosure Among People Living with HIV in Rural Southwestern Uganda. AIDS Behav 2021; 25:2131-2138. [PMID: 33389324 DOI: 10.1007/s10461-020-03143-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
HIV status disclosure remains one of the major challenges to effective HIV prevention. Given the complexities and low rates of disclosure, new innovative strategies are needed. Since electronic adherence monitoring (EAM) are unique mobile devices that light up when transmitting data, those who see them often want to know more about them, which can potentially result in HIV status disclosure. We conducted a qualitative study to explore patient experiences with EAM for antiretroviral therapy (ART) in Uganda with a goal of understanding potential ethical concerns, including disclosure. Unexpectedly, several participants reported intentionally using EAM to facilitate HIV status disclosure to others in order to get social support, encourage HIV testing, and create awareness about HIV. Although researchers and clinicians need to be mindful of the potential for unintended HIV status disclosure through the use of EAM, they should also recognize the potential of this approach to support intended disclosure.
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Affiliation(s)
- Angella Musiimenta
- Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda.
- Angels Compassion Organisation (ACO), Mbarara, Uganda.
| | | | - Wilson Tumuhimbise
- Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda
| | - Bridget Burns
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
| | - Esther C Atukunda
- Mbarara University of Science and Technology, P.O. Box 653, Mbarara, Uganda
| | - Nir Eyal
- School of Public Health and Philosophy, Rutgers University, New Brunswick, NJ, USA
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
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Liu AY, Laborde ND, Coleman K, Vittinghoff E, Gonzalez R, Wilde G, Thorne AL, Ikeguchi E, Shafner L, Sunshine L, van der Straten A, Siegler AJ, Buchbinder S. DOT Diary: Developing a Novel Mobile App Using Artificial Intelligence and an Electronic Sexual Diary to Measure and Support PrEP Adherence Among Young Men Who Have Sex with Men. AIDS Behav 2021; 25:1001-1012. [PMID: 33044687 DOI: 10.1007/s10461-020-03054-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 12/22/2022]
Abstract
Young men who have sex with men (YMSM) are highly vulnerable to HIV. While pre-exposure prophylaxis (PrEP) has demonstrated effectiveness, adherence has been low among YMSM and difficult to measure accurately. In collaboration with a healthcare company, we configured an automated directly-observed therapy (aDOT) platform for monitoring and supporting PrEP use. Based on interest expressed in focus groups among 54 YMSM, we combined aDOT with an electronic sexual diary to provide feedback on level of protection during sex and to motivate app use. In an 8-week optimization pilot with 20 YMSM in San Francisco and Atlanta, the app was found to be highly acceptable, with median System Usability Scale scores in the "excellent" range (80/100). App use was high, with median PrEP adherence of 91% based on aDOT-confirmed dosing. Most (84%) participants reported the app helped with taking PrEP. These promising findings support further evaluation of DOT Diary in future effectiveness studies.
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Affiliation(s)
- Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA.
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
| | | | - Kenneth Coleman
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Rafael Gonzalez
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
| | - Gretchen Wilde
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Annie L Thorne
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | | | | | - Ariane van der Straten
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Women's Global Health Imperative, RTI International, San Francisco, CA, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Susan Buchbinder
- Bridge HIV, San Francisco Department of Public Health, 25 Van Ness Avenue, Suite 100, San Francisco, CA, 94102, USA
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
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12
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Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An Updated Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052477. [PMID: 33802322 PMCID: PMC7967610 DOI: 10.3390/ijerph18052477] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022]
Abstract
Optimal adherence to antiretroviral therapy (ART) remains the bedrock of effective therapy and management of human immunodeficiency virus (HIV). This systematic review examines the effect of interventions in improving ART adherence in sub-Saharan Africa (SSA), which bears the largest global burden of HIV infection. In accordance with PRISMA guidelines, and based on our inclusion and exclusion criteria, PUBMED, MEDLINE, and Google Scholar databases were searched for published studies on ART adherence interventions from 2010 to 2019. Thirty-one eligible studies published between 2010 to 2019 were identified, the categories of interventions were structural, behavioral, biological, cognitive, and combination. Study characteristics varied across design, intervention type, intervention setting, country, and outcome measurements. Many of the studies were behavioral interventions conducted in hospitals with more studies being randomized controlled trial (RCT) interventions. Despite the study variations, twenty-four studies recorded improvements. Notwithstanding, more quality studies such as RCTs should be conducted, especially among key affected populations (KAPs) to control transmission of resistant strains of the virus. Reliable objective measures of adherence should replace the conventional subjective self-report. Furthermore, long-term interventions with longer duration should be considered when evaluating the effectiveness of interventions.
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Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions. Curr HIV/AIDS Rep 2020; 17:301-314. [PMID: 32424549 PMCID: PMC7363551 DOI: 10.1007/s11904-020-00502-5] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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.
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Retention in HIV Care Among HIV-Seropositive Pregnant and Postpartum Women in Uganda: Results of a Randomized Controlled Trial. AIDS Behav 2020; 24:3164-3175. [PMID: 32314120 DOI: 10.1007/s10461-020-02875-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We tested an intervention that aimed to increase retention in antiretroviral therapy (ART) among HIV-positive pregnant and postpartum women, a population shown to be vulnerable to poor ART outcomes. 133 pregnant women initiating ART at 2 hospitals in Uganda used real time-enabled wireless pill monitors (WPM) for 1 month, and were then randomized to receive text message reminders (triggered by late dose-taking) and data-informed counseling through 3 months postpartum or standard care. We assessed "full retention" (proportion attending all monthly clinic visits and delivering at a study facility; "visit retention" (proportion of clinic visits attended); and "postpartum retention" (proportion retained at 3 months postpartum). Intention-to-treat and per protocol analyses found that retention was relatively low and similar between groups, with no significant differences. Retention declined significantly post-delivery. The intervention was unsuccessful in this population, which experiences suboptimal ART retention and is in urgent need of effective interventions.
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Kamal S, Rosen MI, Lazar C, Siqueiros L, Wang Y, Daar ES, Liu H. Perceptions of People Living with HIV and HIV Healthcare Providers on Real-Time Measuring and Monitoring of Antiretroviral Adherence Using Ingestible Sensors: A Qualitative Study. AIDS Res Treat 2020; 2020:1098109. [PMID: 32566285 PMCID: PMC7296466 DOI: 10.1155/2020/1098109] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/25/2020] [Accepted: 05/08/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To describe and analyze the perception and attitudes of people living with HIV (PLWH) and HIV HCPs towards medication adherence with a focus on a digital medicine program (DMP) with ingestible sensors (ISs). METHODS This is a qualitative analysis pilot study of PLWH who were using DMP recruited by purposive sampling. A convenience sample of HCPs was interviewed. Semistructured interviews were conducted, and thematic analysis was performed. RESULTS Fifteen PLWH were interviewed, and thematic analysis resulted in three main themes: self-identified medication adherence patterns, experiences with the DMP, and recommending the DMP to others. Six health care providers (HCPs) described barriers and facilitators to adherence, as well as advantages and disadvantages of using or recommending the DMP to PLWH. CONCLUSION This study evaluated participant and provider responses to DMP, which is a novel technology for real-time measuring and monitoring adherence with the IS. Participant and provider responses were mixed, highlighting both the advantages and limitations of the technology. Practice Implications. Taking PLWH experiences into consideration will enhance the development of this and other useful tools that clinicians and researchers can use for enhanced patient care.
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Affiliation(s)
- Susan Kamal
- University of California, Los Angeles, School of Dentistry, Division of Public Health and Community Dentistry, Los Angeles, CA, USA
| | - Marc I. Rosen
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Christina Lazar
- Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Lisa Siqueiros
- The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Yan Wang
- University of California, Los Angeles, School of Dentistry, Division of Public Health and Community Dentistry, Los Angeles, CA, USA
- University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA, USA
| | - Eric S. Daar
- The Lundquist Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Honghu Liu
- University of California, Los Angeles, School of Dentistry, Division of Public Health and Community Dentistry, Los Angeles, CA, USA
- University of California, Los Angeles, Fielding School of Public Health, Department of Biostatistics, Los Angeles, CA, USA
- University of California, Los Angeles, David Geffen School of Medicine, Department of Medicine, Los Angeles, CA, USA
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MacCarthy S, Mendoza-Graf A, Saya U, Samba C, Birungi J, Okoboi S, Linnemayr S. Lessons learned from a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda. AIDS Care 2020; 32:616-622. [PMID: 31137959 PMCID: PMC6999852 DOI: 10.1080/09540121.2019.1622630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 05/14/2019] [Indexed: 12/12/2022]
Abstract
Evidence suggests that simple text messaging interventions may not suffice to improve ART adherence among youth in low-resource settings. To address this shortcoming, we developed an intervention that shared weekly real-time adherence feedback to youth in Uganda using short message services (SMS), based on information tracked by an electronic device (Wisepill). We present results from 7 formative and 6 exit focus groups (FGs) in Mulago and Entebbe, Uganda with youth ages 15-24, providers, and Community Advisory Board members. Participants consistently conveyed positive impressions of Wisepill, noting that it helped store their medications, facilitated travel, served as a reminder, and motivated adherence. Participants raised phone-related issues before the study; most were addressed but some remained (e.g., limited network access, electricity for powering phones). Further, they highlighted the importance of carefully crafting text messages (e.g., use slang rather than potentially stigmatizing words) and viewed personalizing messages favorably but were divided on the desirability of including their name in study-related texts. Exit FGs confirmed that sharing group adherence levels with participants tapped into the competitive spirit common among youth. Our results suggest future mobile technology-based interventions can be improved by providing messages that go beyond simple reminders to provide individual and group-level adherence feedback.
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Affiliation(s)
- Sarah MacCarthy
- RAND Corporation, Behavioral and Policy Sciences, Santa Monica, CA, USA
| | | | - Uzaib Saya
- Pardee RAND Graduate School, Santa Monica, CA, USA
| | | | | | - Stephen Okoboi
- Infectious Diseases Institute, Makerere University Kampala, Uganda
| | - Sebastian Linnemayr
- RAND Corporation, Economics, Sociology, and Statistics, Santa Monica, CA, USA
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Lucero R, Williams R, Esalomi T, Alexander-Delpech P, Cook C, Bjarnadottir RI. Using an Electronic Medication Event-Monitoring System for Antiretroviral Therapy Self-Management Among African American Women Living With HIV in Rural Florida: Cohort Study. JMIR Form Res 2020; 4:e14888. [PMID: 32130114 PMCID: PMC7057821 DOI: 10.2196/14888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND HIV remains a significant health issue in the United States and disproportionately affects African Americans. African American women living with HIV (AAWH) experience a particularly high number of barriers when attempting to manage their HIV care, including antiretroviral therapy (ART) adherence. To enable the development and assessment of effective interventions that address these barriers to support ART adherence, there is a critical need to understand more fully the use of objective measures of ART adherence among AAWH, including electronic medication dispensers for real-time surveillance. OBJECTIVE This study aimed to evaluate the use of the Wisepill medication event-monitoring system (MEMS) and compare the objective and subjective measures of ART adherence. METHODS We conducted a 30-day exploratory pilot study of the MEMS among a convenience sample of community-dwelling AAWH (N=14) in rural Florida. AAWH were trained on the use of the MEMS to determine the feasibility of collecting, capturing, and manipulating the MEMS data for an objective measure of ART adherence. Self-reported sociodemographic information, including a self-reported measure of ART adherence, was also collected from AAWH. RESULTS We found that the majority of participants were successful at using the electronic MEMS. Daily use of the MEMS tended to be outside of the usual time participants took their medication. Three 30-day medication event patterns were found that characterized ART adherence, specifically uniform and nonuniform medication adherence and nonuniform medication nonadherence. There were relatively few MEMS disruptions among study participants. Overall, adjusted daily ART adherence was 81.08% and subjective ART adherence was 77.78%. CONCLUSIONS This pilot study on the use and evaluation of the Wisepill MEMS among AAWH in rural Florida is the first such study in the United States. The findings of this study are encouraging because 10 out of 12 participants consistently used the MEMS, there were relatively few failures, and objective adjusted daily and overall subjective ART adherence were very similar. On the basis of these findings, we think researchers should consider using the Wisepill MEMS in future studies of AAWH and people living with HIV in the United States after taking into account our practical suggestions. The following practical considerations are suggested when measuring objective medication adherence: (1) before using an MEMS, be familiar with the targeted populations' characteristics; (2) choose an MEMS that aligns with the participants' day-to-day activities; (3) ensure the MEMS' features and resulting data support the research goals; (4) assess the match among the user's ability, wireless features of the MEMS, and the geographic location of the participants; and (5) consider the cost of MEMS and the research budget.
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Affiliation(s)
- Robert Lucero
- Department of Family, Community, and Health Systems Science, Southern HIV & Alcohol Research Consortium, University of Florida, College of Nursing, Gainesville, FL, United States
| | - Renessa Williams
- Department of Family, Community, and Health Systems Science, Southern HIV & Alcohol Research Consortium, University of Florida, College of Nursing, Gainesville, FL, United States
| | - Tanisia Esalomi
- Department of Family, Community, and Health Systems Science, University of Florida, College of Nursing, Gainesville, FL, United States
| | - Paula Alexander-Delpech
- Department of Family, Community, and Health Systems Science, University of Florida, College of Nursing, Gainesville, FL, United States
| | - Christa Cook
- College of Nursing, University of Central Florida, Orlando, FL, United States
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Dworkin MS, Panchal P, Wiebel W, Garofalo R, Jimenez A, Haberer JE. Experience with antiretroviral electronic adherence monitoring among young African American men who have sex with men living with HIV: findings to inform a triaged real-time alert intervention. AIDS Care 2020; 32:1092-1101. [PMID: 31941360 DOI: 10.1080/09540121.2020.1713975] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
We performed a pilot study among young African-American men who have sex with men (AAMSM) of real-time electronic adherence monitoring (EAM) in Chicago to explore acceptability and feasibility of EAM and to inform intervention development. We recruited 40 young AAMSM living with HIV on ART to participate in up to 3 months of monitoring with the Wisepill device. Participants were interviewed at baseline, in response to the first true adjudicated 1-dose, 3-day, and 7-day misses, and at the end of monitoring. Reasons for missing doses and the acceptability and feasibility of electronic monitoring were assessed using mixed methods. The median participant observation time was 90 days (N = 40). For 21 participants with 90 days of follow-up, <90% and <80% adherence occurred in 82% and 79%, respectively in at least one of their monitored months (n = 63 monitored months). The participants generally found the proposed intervention acceptable and useful. Although seven participants said the device attracted attention, none said it led to disclosure of their HIV status. This study found real-time EAM to be generally acceptable and feasible among YAAMSM living with HIV in Chicago. Future work will develop a triaged real-time EAM intervention including text alerts following detection of nonadherence.
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Affiliation(s)
- Mark S Dworkin
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Palak Panchal
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Wayne Wiebel
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Robert Garofalo
- Department of Pediatrics, Northwestern University/Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Antonio Jimenez
- Community Outreach Intervention Projects, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Jessica E Haberer
- Massachusetts General Hospital Center for Global Health, Boston, MA, USA
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Murillo A, DeSilva MB, Sabin LL, Halim N, Chemusto H, Aroda P, Gasuza J, Hamer DH, Williams AL, Mukasa B, Messersmith LJ, Bonawitz R. Impact of a Maternal Prevention of Mother-to-child Transmission of HIV (PMTCT) Intervention on HIV-exposed Infants in Uganda. Int J MCH AIDS 2020; 9:320-329. [PMID: 32765963 PMCID: PMC7397331 DOI: 10.21106/ijma.380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Uganda has successfully reduced pediatric HIV infections through prevention of mother-to-child transmission of HIV (PMTCT) programs, yet little is known about adherence to infant-specific components of interventions. We hypothesized that infants born to mothers receiving the WiseMama (WM) electronic drug monitoring (EDM)-based adherence intervention would have increased uptake of six-week post-natal nevirapine (NVP) infant prophylaxis and better adherence to six-week early infant diagnosis (EID) HIV testing. METHODS At two sites in Uganda, the Wise Infant Study (WIN) prospectively followed an infant cohort. Infants were born to women enrolled in an RCT testing the effect of real-time reminders delivered via EDM on maternal adherence to antiretroviral therapy. We assessed intrapartum and discharge receipt of NVP prophylaxis using pharmacy and infant HIV DNA testing laboratory data. RESULTS Of 121 women eligible for WIN, 97 (80%) consented and enrolled; 46 had been randomized to control and 51 to intervention. There were no differences in receipt of a six-week NVP supply (control 87%, intervention 82%, p = 0.53). Receipt of any NVP prophylaxis did not vary by delivery location (p = 0.35), and although 12% of infants were delivered at non-study health facilities, they were not less likely to receive NVP at discharge (p = 0.37). Among infants with a completed HIV test, there was no difference in mean time to first test (control 52 days (SD 18), intervention 51 days (SD 15), p = 0.86). Only one infant, in the control group, tested positive for HIV. CONCLUSION AND GLOBAL HEALTH IMPLICATIONS We found no significant differences in adherence to infant PMTCT practices between intervention and control infants with relatively high rates of NVP receipt albeit with suboptimal adherence to six-week EID testing. Further work is needed to ensure improved access, uptake, and follow-up of HIV-exposed infants in the Option B+ era.
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Affiliation(s)
- Anays Murillo
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA
| | | | - Lora L Sabin
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA
| | - Nafisa Halim
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA
| | | | - Philip Aroda
- Mildmay Uganda, Lweza Kampala-Entebbe Road, Kampala, Uganda
| | - Julia Gasuza
- Mildmay Uganda, Lweza Kampala-Entebbe Road, Kampala, Uganda
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118 USA
| | - Anna Larson Williams
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA
| | - Barbara Mukasa
- Mildmay Uganda, Lweza Kampala-Entebbe Road, Kampala, Uganda
| | - Lisa J Messersmith
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA
| | - Rachael Bonawitz
- Department of Global Health, Boston University School of Public Health, Boston University, 801 Massachusetts Avenue Crosstown Center, 3 Floor, Boston, MA, 02118 USA.,Section of Hospital Medicine, Department of Pediatrics, Saint Christopher's Hospital for Children, 160 East Erie Avenue, Philadelphia, PA, 19134 USA.,Department of Pediatrics, Drexel University College of Medicine, 2900 W Queen Ln, Philadelphia, PA, 19129 USA
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If You Build It, Will They Use It? Preferences for Antiretroviral Therapy (ART) Adherence Monitoring Among People Who Inject Drugs (PWID) in Kazakhstan. AIDS Behav 2019; 23:3294-3305. [PMID: 30741397 DOI: 10.1007/s10461-019-02421-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adherence to antiretroviral therapy (ART) is an important predictor of long-term treatment success and is associated with optimal individual and public health outcomes. Novel technologies, such as electronic monitoring devices (EMDs) or pharmacokinetic testing, provide more objective measures of ART adherence than traditional measures of adherence (e.g., self-report) and may facilitate improved adherence through the provision of patient feedback. This study examines preferences for ART adherence monitoring among people who inject drugs (PWID) in Kazakhstan. In-depth interviews were conducted with 20 HIV-positive PWID, 18 of their intimate partners, and 7 AIDS Center healthcare providers in Almaty, Kazakhstan. Results indicated that patients varied in their preferences of which strategies would be most effective and acceptable to use in monitoring their adherence. Overall, patients were highly enthusiastic about the potential use of pharmacokinetic testing. Many participants supported the use of EMDs, though some were concerned about having their adherence tracked. Other participants thought reminders through text messaging or smart phone applications would be helpful, though several had concerns about confidentiality and others worried about technological difficulties operating a smart phone. Future studies should evaluate the feasibility and impact of providing quantitative drug levels as feedback for ART adherence using biomarkers of longer-term ART exposure, (i.e., hair sampling or dried blood spot testing).
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Use of the FITT framework to understand patients' experiences using a real-time medication monitoring pill bottle linked to a mobile-based HIV self-management app: A qualitative study. Int J Med Inform 2019; 131:103949. [PMID: 31561192 DOI: 10.1016/j.ijmedinf.2019.08.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/14/2019] [Accepted: 08/08/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The purpose of this work was to conduct an in-depth analysis to understand patients' experiences using a real-time medication monitoring pill bottle linked to an HIV self-management app. METHODS A descriptive qualitative study design was used. In-depth interviews were conducted using a semi-structured interview guide at the 3-month follow-up visit during a trial of the app for improving medication adherence which began in January 2018. Eligibility criteria were HIV-positive, over the age of 18, ownership of a smartphone, able to speak and understand English and self-report less than 80% adherence to medications in the past 30 days or a viral load of over 20 copies/mL (detectable). All interviews were audio-recorded and transcribed. Using thematic analysis, we explored emerging themes with similar patterns across interviews and organized the themes according to the constructs of the Fit between Individuals, Task and Technology (FITT) framework. RESULTS Thirty-eight persons living with HIV (PLWH), who were randomized to the intervention arm of the study trial, participated in the interviews. 79.0% of participants reported their race as African American/Black, 63.2% had completed some high school or less, and 79.0% reported an annual median income of less than $20,000. Data was collected until saturation was reached. A total of nine major themes organized by the FITT framework were identified. Three themes related to the fit between individuals and task were: motivation for strict medication adherence, self-efficacy for overall health management, and engagement with medication reminders. Four themes related to the fit between individual and technology were: ease of use, HIV-related stigma and disclosure of HIV status, customized alert of medication time windows based on individual routine set-up, and preference for device design. Two themes related to the fit between task and technology were: system functionality of data transfer from the electronic pill bottle to the app and self-awareness of system syncing signals. CONCLUSIONS This study demonstrated that tracking medication adherence and receiving push-notification medication reminders through the electronic pill bottle connected to the app encourages and supports PLWH in adhering to their medication regimens. Findings from this work highlight the importance of adequate consideration of the needs of intended users in designing customizable mobile health technology, including HIV-related stigma, disclosure of HIV status and antiretroviral therapy regimens.
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Sumari-de Boer M, Pima FM, Ngowi KM, Chelangwa GM, Mtesha BA, Minja LM, Semvua HH, Mpagama S, Mmbaga BT, Nieuwkerk PT, Aarnoutse RE. Implementation and effectiveness of evriMED with short messages service (SMS) reminders and tailored feedback compared to standard care on adherence to treatment among tuberculosis patients in Kilimanjaro, Tanzania: proposal for a cluster randomized controlled trial. Trials 2019; 20:426. [PMID: 31300028 PMCID: PMC6626331 DOI: 10.1186/s13063-019-3483-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to tuberculosis (TB) treatment is challenging because of many factors. The World Health Organization has recommended the use of digital adherence monitoring technologies in its End TB Strategy. However, evidence on improving adherence is limited. EvriMED is a real-time medication-monitoring device which was found to be feasible and acceptable in a few studies in Asia. In Tanzania, however, there may be challenges in implementing evriMED due to stigmatization, network and power access, accuracy, and cost effectiveness, which may have implications for treatment outcome. We propose a pragmatic cluster randomized trial to investigate the effectiveness of evriMED with reminder cues and tailored feedback on adherence to TB treatment in Kilimanjaro, Tanzania. METHODS/DESIGN We will create clusters in Kilimanjaro based on level of health care facility. Clusters will be randomized in an intervention arm, where evriMED will be implemented, or a control arm, where standard practice directly observed treatment will be followed. TB patients in intervention clusters will take their medication from the evriMED pillbox and receive tailored feedback. We will use the 'Stages of Change' model, which assumes that a person has to go through the stages of pre-contemplation, contemplation, preparation, action, and evaluation to change behavior for tailored feedback on adherence reports from the device. DISCUSSION If the intervention shows a significant effect on adherence and the devices are accepted, accurate, and sustainable, the intervention can be scaled up within the National Tuberculosis Programmes. TRIAL REGISTRATION Pan African Clinical Trials Registry, PACTR201811755733759 . Registered on 8 November 2018.
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Affiliation(s)
- Marion Sumari-de Boer
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania. .,Department of International Health, RadboudUMC, Nijmegen, the Netherlands.
| | - Francis M Pima
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania
| | - Kennedy M Ngowi
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania.,Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands.,Medical psychologypsychology, AMC, AZ, 9 1105, Meibergdreef, Amsterdam, Netherlands
| | | | - Benson A Mtesha
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania
| | - Linda M Minja
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania
| | - Hadija H Semvua
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania
| | - Stella Mpagama
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Clinical Research Institute (KCRI), PO Box 2236, Moshi, Tanzania
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Rob E Aarnoutse
- Department of Clinical Pharmacology, RadboudUMC, Nijmegen, the Netherlands
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23
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Castillo-Mancilla JR, Haberer JE. Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring. Curr HIV/AIDS Rep 2019; 15:49-59. [PMID: 29380227 DOI: 10.1007/s11904-018-0377-0] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW In this review, we present new developments in antiretroviral adherence, focusing on pharmacological measures and real-time adherence monitoring. In addition, new strategies on how to incorporate these new measures into research and clinical care are proposed. RECENT FINDINGS Antiretroviral drug concentrations in hair and dried blood spots are two novel pharmacological measures of cumulative drug adherence and exposure that have been recently evaluated in HIV treatment and pre-exposure prophylaxis. Real-time adherence monitoring using electronic devices has also proven highly informative, feasible, and well accepted, offering the possibility for an immediate intervention when non-adherence is detected. Both approaches offer considerable advantages over traditional adherence measures in predicting efficacy. New methods to objectively monitor adherence in real-time and over long time periods have been developed. Further research is required to better understand how these measures can optimize adherence and, ultimately, improve clinical outcomes in HIV treatment and prevention.
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Affiliation(s)
- Jose R Castillo-Mancilla
- Division of Infectious Diseases, Department of Medicine, University of Colorado Anschutz Medical Campus, Medicine/Infectious Diseases, 12700 E 19th Ave., B168, Aurora, CO, 80045, USA.
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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24
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Stringer KL, Azuero A, Ott C, Psaros C, Jagielski CH, Safren SA, Haberer JE, Kempf MC. Feasibility and Acceptability of Real-Time Antiretroviral Adherence Monitoring among Depressed Women Living with HIV in the Deep South of the US. AIDS Behav 2019; 23:1306-1314. [PMID: 30377982 DOI: 10.1007/s10461-018-2322-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study presents feasibility and acceptability data on the use of a real-time wireless electronic adherence monitor (EAM), among African American women living with HIV with co-occurring depression, residing in remote areas of the Southeastern United States. EAM and self-report ART adherence was monitored over an average of 14.8 weeks among 25 participants who were recruited at four HIV clinics in Alabama. Intra-class correlation showed a low degree of concordance between EAM and self-report (ICC = 0.33, 95% bootstrap CI 0.13, 0.59). 83% of data collected via EAM was transmitted in real-time. Due to technological failures, 11.4% were not transmitted in real-time, but were later recovered, and 5.7% were lost entirely. Acceptability was examined through surveys and qualitative interviews. Results suggest that EAM monitoring is acceptable and feasible in a rural US setting; however, technological difficulties, such as loss of connectivity may impede the device's usefulness for just-in-time adherence interventions.
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Affiliation(s)
| | - Andres Azuero
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Corilyn Ott
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina Psaros
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Jessica E Haberer
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Mirjam-Colette Kempf
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA.
- Departments of Health Behavior and Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
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25
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Castel AD, Qasmieh S, Greenberg D, Ellenberger N, Howell TH, Griffith C, Wilbourn BC, Ganesan K, Hussein N, Ralte G, Rakhmanina N. Digital Gaming to Improve Adherence Among Adolescents and Young Adults Living With HIV: Mixed-Methods Study to Test Feasibility and Acceptability. JMIR Serious Games 2018; 6:e10213. [PMID: 30322838 PMCID: PMC6231793 DOI: 10.2196/10213] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/27/2018] [Accepted: 07/17/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. OBJECTIVE We assessed the feasibility and acceptability of video gaming to improve AYA ART adherence. METHODS Focus group discussions and surveys were administered to health care providers and AYA aged 13 to 24 years living with HIV at a pediatric HIV program in Washington, DC. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. RESULTS Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. CONCLUSIONS AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV.
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Affiliation(s)
- Amanda D Castel
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Saba Qasmieh
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | | | | | - Tyriesa Howard Howell
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
- Center for Prevention Science, School of Social Work, Rutgers University, New Brunswick, NJ, United States
| | - Caleb Griffith
- Children's National Health System, Washington, DC, United States
| | - Brittany C Wilbourn
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Kavitha Ganesan
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States
- Walter Reed Army Institute of Research, United States Military HIV Research Program, Silver Spring, MD, United States
| | - Nadia Hussein
- Children's National Health System, Washington, DC, United States
| | | | - Natella Rakhmanina
- Children's National Health System, Washington, DC, United States
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC, United States
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States
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26
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Stekler JD, Scanlan JM, Simoni JM, Crane HM, Fredericksen RJ, Marquard J, Saver BG. Predictors of Art and PrEP Adherence and Medication-Taking Practices and Preferences to Inform Development of a Wrist-Worn Adherence System. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:357-368. [PMID: 30332308 DOI: 10.1521/aeap.2018.30.5.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined adherence, medication-taking practices, and preferences to inform development of a wrist-worn adherence system. Two convenience samples of persons taking antiretroviral therapy and HIV pre-exposure prophylaxis completed a survey. Additional online questions asked about willingness to use a wrist-worn device and reminder and feedback preferences. Among 225 participants, 13% reported adherence < 90%; this was associated with younger age and clinic sample. Compared to pill bottle-using participants, mediset users less commonly reported adherence < 90% (aOR = 0.16, p = .02), and blister pack users (aOR = 6.3, p = .02) and pill roll users (aOR = 3.3, p = .04) more commonly reported adherence < 90%. Sixty-two percent of the online participants reporting adherence (< 100%) had some interest in receiving adherence reminders, including 42% with interest in receiving reminders by smartwatch notifications. Although confounders are likely, formative work identified potential users and interest in using a wrist-worn adherence system. Future work will determine its acceptability and efficacy.
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Affiliation(s)
| | | | | | | | | | | | - Barry G Saver
- Swedish Center for Research and Innovation, Seattle
- University of Massachusetts, Amherst, Massachusetts
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27
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Musiimenta A, Atukunda EC, Tumuhimbise W, Pisarski EE, Tam M, Wyatt MA, Ware NC, Haberer JE. Acceptability and Feasibility of Real-Time Antiretroviral Therapy Adherence Interventions in Rural Uganda: Mixed-Method Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e122. [PMID: 29773527 PMCID: PMC5981052 DOI: 10.2196/mhealth.9031] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 01/11/2018] [Accepted: 03/19/2018] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Wireless electronic adherence monitors can detect antiretroviral therapy (ART) adherence lapses and trigger interventions in real time, thus potentially avoiding unnecessary HIV viremia. Evidence about the acceptability and feasibility of these monitors and associated interventions, however, is limited. OBJECTIVE The aim of this study was to assess the acceptability and feasibility of real-time adherence monitoring linked to text messaging (short message service, SMS) reminders and notifications to support adherence among individuals living with HIV who are taking ART in rural southwestern Uganda. METHODS Individuals living with HIV who were initiating ART were enrolled in a pilot randomized controlled trial and followed up for 9 months. Participants received a real-time adherence monitor and were randomized to one of the following study arms: (1) scheduled SMS, (2) SMS triggered by missed or delayed doses, or (3) no SMS. SMS notifications were also sent to 45 patient-identified social supporters for sustained adherence lapses in the scheduled SMS and triggered SMS arms. Study participants and social supporters participated in qualitative semistructured in-depth interviews on acceptability and feasibility of this technology. An inductive, content analytic approach, framed by the unified theory of acceptance and use of technology model, was used to analyze qualitative data. Quantitative feasibility data, including device functionality and SMS tracking data, were recorded based upon device metrics collected electronically and summarized descriptively. RESULTS A total of 63 participants participated in the study. Participants reported that real-time monitoring intervention linked to SMS reminders and notifications are generally acceptable; the predominant feedback was perceived utility-the intervention was beneficial in motivating and reminding patients to take medication, as well as enabling provision of social support. The intervention was found to be technically feasible, as data were obtained from most participants as expected most of the time. Potential challenges included the impact of the technology on confidentiality, shared phone ownership, usability skills, and availability of electricity. CONCLUSIONS Real-time adherence monitoring integrated with SMS reminders and social support notifications is a generally acceptable (based primarily on perceived utility) and feasible intervention in a resource-limited country. Future efforts should focus on optimized device design, user training to overcome the challenges we encountered, cost effectiveness studies, as well as studying the monitoring aspect of the device without accompanying interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT01957865; https://clinicaltrials.gov/ct2/show/NCT01957865 (Archived by WebCite at http://www.webcitation.org/6zFiDlXDa).
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Affiliation(s)
| | | | | | | | - Melanie Tam
- Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Monique A Wyatt
- Harvard Medical School, Boston, MA, United States
- Harvard Global, Cambridge, MA, United States
| | - Norma C Ware
- Harvard Medical School, Boston, MA, United States
| | - Jessica E Haberer
- Harvard Medical School and Massachusetts General Hospital, Boston, MA, United States
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28
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Sabin LL, Mansfield L, DeSilva MB, Vian T, Li Z, Wubin X, Gifford AL, Barnoon Y, Gill CJ. Why it Worked: Participants' Insights into an mHealth Antiretroviral Therapy Adherence Intervention in China. Open AIDS J 2018; 12:20-37. [PMID: 29576816 PMCID: PMC5850484 DOI: 10.2174/1874613601812010020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/15/2017] [Accepted: 01/15/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Few Antiretroviral Therapy (ART) adherence trials investigate the reasons for intervention success or failure among HIV-positive individuals. Objectives: To conduct qualitative research to explore the reasons for effectiveness of a 6-month mHealth (mobile health) trial that improved adherence among ART patients in China. The intervention utilized Wireless Pill Containers (WPCs) to provide, real-time SMS reminders, WPC-generated adherence reports, and report-informed counseling. Methods: We conducted in-depth interviews with 20 intervention-arm participants immediately following the trial. Sampling was purposeful to ensure inclusion of participants with varied adherence histories. Questions covered adherence barriers and facilitators, and intervention experiences. We analyzed data in nVivo using a thematic approach. Results: Of participants, 14 (70%) were male; 7 (35%) had used injectable drugs. Pre-intervention, 11 were optimal adherers and 9 were suboptimal adherers, using a 95% threshold. In the final intervention month, all but 3 (85%) attained optimal adherence. Participants identified a range of adherence barriers and facilitators, and described various mechanisms for intervention success. Optimal adherers at baseline were motivated by positive adherence reports at monthly clinic visits-similar to receiving A+ grades. For suboptimal adherers, reminders facilitated the establishment of adherence-promoting routines; data-guided counseling helped identify strategies to overcome specific barriers. Conclusion: Different behavioral mechanisms appear to explain the success of an mHealth adherence intervention among patients with varying adherence histories. Positive reinforcement was effective for optimal adherers, while struggling patients benefitted from reminders and data-informed counseling. These findings are relevant for the design and scalability of mHealth interventions and warrant further investigation.
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Affiliation(s)
- Lora L Sabin
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
| | - Lauren Mansfield
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
| | | | - Taryn Vian
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
| | - Zhong Li
- FHI 360, Room B110, Floor 4, Building 1, No.15, Guanghua Road, Chaoyang District, Beijing, 100026, China
| | - Xie Wubin
- Department of Global Health, Milken Institute School of Public Health, George Washington University, 2121 I St NW, Washington, D.C., 20052, USA
| | - Allen L Gifford
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave, Boston, MA, 02130, USA.,Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Yiyao Barnoon
- Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Christopher J Gill
- Department of Global Health, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown, 3rd floor, Boston, MA, 02118, USA
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29
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Koss CA, Hosek SG, Bacchetti P, Anderson PL, Liu AY, Horng H, Benet LZ, Kuncze K, Louie A, Saberi P, Wilson CM, Gandhi M. Comparison of Measures of Adherence to Human Immunodeficiency Virus Preexposure Prophylaxis Among Adolescent and Young Men Who Have Sex With Men in the United States. Clin Infect Dis 2018; 66:213-219. [PMID: 29020194 PMCID: PMC5850042 DOI: 10.1093/cid/cix755] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023] Open
Abstract
Background Young men-who-have-sex-with-men (MSM) are disproportionately impacted by human immunodeficiency virus (HIV). Preexposure prophylaxis (PrEP) could reduce HIV acquisition among youth, but suboptimal adherence threatens effectiveness. Optimal metrics of PrEP adherence among adolescents have remain undefined. Methods The Adolescent Trials Network 110/113 studies provided daily oral PrEP with tenofovir (TFV) disoproxil fumarate/emtricitabine over 48 weeks to a diverse population of MSM (aged 15-22 years). Self-reported adherence was assessed and PrEP drug concentrations measured from hair and dried blood spot (DBS) samples; 23% of participants received Wisepill electronic monitoring devices. The average number of PrEP doses per week taken was estimated, and concordance between measures assessed. Results Among 243 participants, hair samples were collected at 1186/1238 (96%) person-visits. The concordance of TFV levels in hair and TFV-diphosphate in DBS around thresholds consistent with taking ≥4 and 7 PrEP doses/week was high (76% and 80%). Hair and DBS concentrations correlated poorly with self-report and Wisepill metrics. Through week 12, 40%-60% of participants (by hair and DBS), ≤31% (Wisepill), and >85% (self-report) were estimated to have taken ≥4 PrEP doses/week (a threshold associated with protection among MSM). For all measures except self-report, adherence declined over time, with half of participants taking <2 doses/week by week 48. Conclusions Among youth on PrEP, adherence waned over time. Self-report overestimated adherence, and use of Wisepill was limited. Hair collection was highly acceptable and provided similar interpretations to DBS. Incorporation of either metric in future PrEP studies among youth could identify suboptimal adherence and trigger interventions.
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Affiliation(s)
| | - Sybil G Hosek
- Department of Psychiatry, John Stroger Hospital of Cook County, Chicago, Illinois
| | - Peter Bacchetti
- Department of Epidemiology and Biostatistics, University of California San Francisco
| | - Peter L Anderson
- Department of Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, California
| | - Howard Horng
- Department of Medicine, University of California San Francisco
| | - Leslie Z Benet
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco
| | - Karen Kuncze
- Department of Medicine, University of California San Francisco
| | - Alexander Louie
- Department of Medicine, University of California San Francisco
| | - Parya Saberi
- Department of Medicine, University of California San Francisco
| | - Craig M Wilson
- Department of Epidemiology, University of Alabama Birmingham
| | - Monica Gandhi
- Department of Medicine, University of California San Francisco
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30
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Pellowski JA, Kalichman SC, Cherry S, Conway-Washington C, Cherry C, Grebler T, Krug L. The Daily Relationship Between Aspects of Food Insecurity and Medication Adherence Among People Living with HIV with Recent Experiences of Hunger. Ann Behav Med 2017; 50:844-853. [PMID: 27333898 DOI: 10.1007/s12160-016-9812-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Limited access to resources can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between lacking access to nutritious food and antiretroviral (ARV) medication non-adherence in a variety of social contexts. PURPOSE This study aims to determine if several aspects of food insecurity co-occur with missed doses of medication on a daily basis among a sample of people living with HIV who have recently experienced hunger. METHODS The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Participants were followed for 45 days and completed daily assessments of food insecurity and alcohol use via interactive text message surveys and electronic medication adherence monitoring using the Wisepill. RESULTS Fifty-nine men and women living with HIV contributed a total of 2,655 days of data. Results showed that severe food insecurity (i.e., hunger), but not less severe food insecurity (i.e., worrying about having food), significantly predicted missed doses of medication on a daily level. Daily alcohol use moderated this relationship in an unexpected way; when individuals were hungry and drank alcohol on a given day, they were less likely to miss a dose of medication. CONCLUSIONS Among people living with HIV with recent experiences of hunger, this study demonstrates that there is a daily relationship between hunger and non-adherence to antiretroviral therapy. Future research is needed to test interventions designed to directly address the daily relationship between food insecurity and medication non-adherence.
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Affiliation(s)
- Jennifer A Pellowski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Sabrina Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | | | - Chauncey Cherry
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Tamar Grebler
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Larissa Krug
- Department of Psychology, University of Connecticut, Storrs, CT, USA
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31
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Andriesen J, Bull S, Dietrich J, Haberer JE, Van Der Pol B, Voronin Y, Wall KM, Whalen C, Priddy F. Using Digital Technologies in Clinical HIV Research: Real-World Applications and Considerations for Future Work. J Med Internet Res 2017; 19:e274. [PMID: 28760729 PMCID: PMC5556256 DOI: 10.2196/jmir.7513] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 04/26/2017] [Accepted: 04/29/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Digital technologies, especially if used in novel ways, provide a number of potential advantages to clinical research in trials related to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) and may greatly facilitate operations as well as data collection and analysis. These technologies may even allow answering questions that are not answerable with older technologies. However, they come with a variety of potential concerns for both the participants and the trial sponsors. The exact challenges and means for alleviation depend on the technology and on the population in which it is deployed, and the rapidly changing landscape of digital technologies presents a challenge for creating future-proof guidelines for technology application. OBJECTIVE The aim of this study was to identify and summarize some common themes that are frequently encountered by researchers in this context and highlight those that should be carefully considered before making a decision to include these technologies in their research. METHODS In April 2016, the Global HIV Vaccine Enterprise surveyed the field for research groups with recent experience in novel applications of digital technologies in HIV clinical research and convened these groups for a 1-day meeting. Real-world uses of various technologies were presented and discussed by 46 attendees, most of whom were researchers involved in the design and conduct of clinical trials of biomedical HIV prevention and treatment approaches. After the meeting, a small group of organizers reviewed the presentations and feedback obtained during the meeting and categorized various lessons-learned to identify common themes. A group of 9 experts developed a draft summary of the findings that was circulated via email to all 46 attendees for review. Taking into account the feedback received, the group finalized the considerations that are presented here. RESULTS Meeting presenters and attendees discussed the many successful applications of digital technologies to improve research outcomes, such as those for recruitment and enrollment, participant identification, informed consent, data collection, data quality, and protocol or treatment adherence. These discussions also revealed unintended consequence of technology usage, including risks to study participants and risks to study integrity. CONCLUSIONS Key lessons learned from these discussions included the need to thoroughly evaluate systems to be used, the idea that early success may not be sustained throughout the study, that some failures will occur, and considerations for study-provided devices. Additionally, taking these key lessons into account, the group generated recommendations on how to move forward with the use of technology in HIV vaccine and biomedical prevention trials.
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Affiliation(s)
| | - Sheana Bull
- Colorado School of Public Health, Denver, CO, United States
| | - Janan Dietrich
- Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Soweto, South Africa
| | - Jessica E Haberer
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, United States
| | | | - Yegor Voronin
- Global HIV Vaccine Enterprise, New York, NY, United States
| | | | - Christopher Whalen
- Research Data & Communications Technologies Corp., Garrett Park, MD, United States
| | - Frances Priddy
- International AIDS Vaccine Initiative, New York, NY, United States
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32
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Nhavoto JA, Grönlund Å, Klein GO. Mobile health treatment support intervention for HIV and tuberculosis in Mozambique: Perspectives of patients and healthcare workers. PLoS One 2017; 12:e0176051. [PMID: 28419149 PMCID: PMC5395223 DOI: 10.1371/journal.pone.0176051] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 04/04/2017] [Indexed: 11/20/2022] Open
Abstract
Background Studies have been conducted in developing countries using SMS to communicate with patients to reduce the number of missed appointments and improve retention in treatment, however; very few have been scaled up. One possible reason for this could be that patients or staff are dissatisfied with the method in some way. This paper reports a study of patients’ and healthcare workers’ (HCW) views on an mHealth intervention aiming to support retention in antiretroviral therapy (ART) and tuberculosis (TB) treatment in Mozambique. Methods The study was conducted at five healthcare centres in Mozambique. Automated SMS health promotions and reminders were sent to patients in a RCT. A total of 141 patients and 40 HCWs were interviewed. Respondents rated usefulness, perceived benefits, ease of use, satisfaction, and risks of the SMS system using a Likert scale questionnaire. A semi-structured interview guide was followed. Interviews were transcribed and thematic analysis was conducted. Results Both patients and HCW found the SMS system useful and reliable. Most highly rated positive effects were reducing the number of failures to collect medication and avoiding missing appointments. Patients’ confidence in the system was high. Most perceived the system to improve communication between health-care provider and patient and assist in education and motivation. The automatic recognition of questions from patients and the provision of appropriate answers (a unique feature of this system) was especially appreciated. A majority would recommend the system to other patients or healthcare centres. Risks also were mentioned, mostly by HCW, of unintentional disclosure of health status in cases where patients use shared phones. Conclusions The results suggest that SMS technology for HIV and TB should be used to transmit reminders for appointments, medications, motivational texts, and health education to increase retention in care. Measures must be taken to reduce risks of privacy intrusion, but these are not a main obstacle for scaling up systems of this kind.
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Affiliation(s)
- José António Nhavoto
- Informatics, School of Business, Örebro University, Örebro, Sweden
- Informatics, Department of Mathematics and Informatics, Eduardo Mondlane University, Maputo, Mozambique
| | - Åke Grönlund
- Informatics, School of Business, Örebro University, Örebro, Sweden
| | - Gunnar O Klein
- Informatics, School of Business, Örebro University, Örebro, Sweden
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Haberer JE, Sabin L, Amico KR, Orrell C, Galárraga O, Tsai AC, Vreeman RC, Wilson I, Sam‐Agudu NA, Blaschke TF, Vrijens B, Mellins CA, Remien RH, Weiser SD, Lowenthal E, Stirratt MJ, Sow PS, Thomas B, Ford N, Mills E, Lester R, Nachega JB, Bwana BM, Ssewamala F, Mbuagbaw L, Munderi P, Geng E, Bangsberg DR. Improving antiretroviral therapy adherence in resource-limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc 2017; 20:21371. [PMID: 28630651 PMCID: PMC5467606 DOI: 10.7448/ias.20.1.21371] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 02/24/2017] [Indexed: 01/01/2023] Open
Abstract
Introduction: Successful population-level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale-up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource-limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource-limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta-analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low- and middle-income countries. Interventions are categorized broadly as education and counselling; information and communication technology-enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource-limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi-media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.
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Affiliation(s)
- Jessica E. Haberer
- Massachusetts General Hospital Global Health, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lora Sabin
- Department of Global Health, Center for Global Health and Department, Boston University School of Public Health, Boston, MA, USA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Alexander C. Tsai
- Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel C. Vreeman
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
| | - Nadia A. Sam‐Agudu
- Clinical Department, Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Terrence F. Blaschke
- Department of Medicine and Clinical Pharmacology, Stanford University School of Medicine, Stanford, CA, USA
| | - Bernard Vrijens
- Department of Biostatistics, University of Liège, Liège, Wallonia, Belgium
- WestRock Healthcare, Sion, Switzerland
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University, New York, NY, USA
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, NYSPI and Department of Psychiatry, Columbia; University, New York, NY, USA
| | - Sheri D. Weiser
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Elizabeth Lowenthal
- Departments of Pediatrics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | - Michael J. Stirratt
- Division of AIDS Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Papa Salif Sow
- Bill and Melinda Gates Foundation, Seattle, WA, USA
- Department of Infectious diseases, University of Dakar, Dakar, Sénégal
| | | | - Nathan Ford
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
| | - Edward Mills
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Richard Lester
- Division of Infectious Diseases, Department of Medicine, University of British Columbia
| | - Jean B. Nachega
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Bosco Mwebesa Bwana
- Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Fred Ssewamala
- Columbia University School of Social Work & School of International and Public Affairs, New York, NY, USA
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Paula Munderi
- HIV Care Research Program, Medical Research Council, Uganda Virus Research Institute, Entebbe, Uganda
| | - Elvin Geng
- Division of HIV, Infectious Disease and Global Medicine, San Francisco General Hospital, Department of Medicine, University of California, San Francisco, CA, USA
| | - David R. Bangsberg
- Oregon Health & Sciences University‐Portland State University School of Public Health, Portland, OR, USA
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Cell Phone-Based and Adherence Device Technologies for HIV Care and Treatment in Resource-Limited Settings: Recent Advances. Curr HIV/AIDS Rep 2016; 12:523-31. [PMID: 26439917 DOI: 10.1007/s11904-015-0282-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Numerous cell phone-based and adherence monitoring technologies have been developed to address barriers to effective HIV prevention, testing, and treatment. Because most people living with HIV and AIDS reside in resource-limited settings (RLS), it is important to understand the development and use of these technologies in RLS. Recent research on cell phone-based technologies has focused on HIV education, linkage to and retention in care, disease tracking, and antiretroviral therapy adherence reminders. Advances in adherence devices have focused on real-time adherence monitors, which have been used for both antiretroviral therapy and pre-exposure prophylaxis. Real-time monitoring has recently been combined with cell phone-based technologies to create real-time adherence interventions using short message service (SMS). New developments in adherence technologies are exploring ingestion monitoring and metabolite detection to confirm adherence. This article provides an overview of recent advances in these two families of technologies and includes research on their acceptability and cost-effectiveness when available. It additionally outlines key challenges and needed research as use of these technologies continues to expand and evolve.
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Raiff BR, Jarvis BP, Dallery J. Text-message reminders plus incentives increase adherence to antidiabetic medication in adults with type 2 diabetes. J Appl Behav Anal 2016; 49:947-953. [PMID: 27417877 DOI: 10.1002/jaba.337] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/01/2016] [Indexed: 11/08/2022]
Abstract
Some adults with Type 2 diabetes mellitus have difficulty adhering to their oral medication regimens. The current study used a multiple baseline design with 3 adults with Type 2 diabetes. Medication taking was monitored remotely in real time via an electronic pill bottle. During the intervention, monetary incentives were delivered contingent on evidence of adherence to taking medication at specified times. Text-message reminders were also sent if medication was not taken. Adherence increased for all participants. Future studies should separate the relative contributions of text-message and incentive components of the intervention.
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Pellowski JA, Kalichman SC, Kalichman MO, Cherry C. Alcohol-antiretroviral therapy interactive toxicity beliefs and daily medication adherence and alcohol use among people living with HIV. AIDS Care 2016; 28:963-70. [PMID: 26964014 DOI: 10.1080/09540121.2016.1154134] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol-antiretroviral therapy (ART) interactive toxicity beliefs reflect perceived adverse outcomes of mixing alcohol and ART. Previous research has shown a significant relationship between alcohol-ART interactive toxicity beliefs and ART non-adherence, over and above other correlates of non-adherence such as human immunodeficiency virus (HIV)symptoms and frequency of alcohol use. Most past studies have collected data over extended periods and have not determined if alcohol use and missed medications occur at the day-level among people holding interactive toxicity beliefs. Previous daily analyses, however, have been limited by self-reported adherence and relatively short periods of observation. To address these gaps in the literature, men and women living with HIV in Atlanta, GA, were enrolled in a 45-day observational cohort study. Daily alcohol use was collected using two-way interactive text message surveys and daily adherence was collected via the Wisepill device. Fifty-seven participants completed a measure of alcohol-ART interactive toxicity beliefs and contributed 2565 days of daily data. Participants who endorsed high levels of interactive toxicity beliefs had significantly more days when they missed doses of medication. Alcohol-antiretroviral toxicity beliefs predicted missing doses of medication on days when participants were drinking and on days when they were not drinking. Multilevel multivariate regressions showed that these toxicity beliefs predicted daily missed doses of medication over and above quantity of alcohol consumed, depression and general medication concerns. This study replicates and extends previous literature and indicates the necessity of addressing alcohol-ART toxicity beliefs within adherence interventions.
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Affiliation(s)
- Jennifer A Pellowski
- a Department of Psychiatry and Human Behavior , The Warren Alpert Medical School of Brown University , Providence , RI , USA
| | - Seth C Kalichman
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Moira O Kalichman
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
| | - Chauncey Cherry
- b Department of Psychology , University of Connecticut , Storrs , CT , USA
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37
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Campbell JI, Eyal N, Musiimenta A, Haberer JE. Ethical Questions in Medical Electronic Adherence Monitoring. J Gen Intern Med 2016; 31:338-42. [PMID: 26358284 PMCID: PMC4762813 DOI: 10.1007/s11606-015-3502-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 05/15/2015] [Accepted: 08/14/2015] [Indexed: 11/30/2022]
Abstract
Electronic adherence monitors (EAMs) record and report an array of health behaviors, ranging from taking daily medications to wearing medical devices. EAMs are utilized in research worldwide and are being investigated for clinical use. However, there is also growing popular concern about the extent to which electronic devices may be used to monitor individuals, including allegations in the media that EAMs represent a move towards "Big Brother" in medicine. Here, we highlight the unique benefits as well as the potential ethical challenges that electronic adherence monitoring generates. These challenges surround autonomy, privacy and confidentiality, trust, and ancillary care obligations. We describe key questions within each of these domains that warrant further investigation, and present potential solutions to many of the concerns raised.
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Affiliation(s)
| | - Nir Eyal
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Angella Musiimenta
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jessica E Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
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Young SD, Swendeman D, Holloway IW, Reback CJ, Kao U. Use of Technology to Address Substance Use in the Context of HIV: A Systematic Review. Curr HIV/AIDS Rep 2015; 12:462-71. [PMID: 26475670 PMCID: PMC4749410 DOI: 10.1007/s11904-015-0295-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Substance users are at elevated risk for HIV. HIV researchers, particularly at the intersection of HIV and substance use, have requested new methods to better understand and address this important area. New technologies, such as social media and mobile applications, are increasingly being used as research tools in studies on HIV and substance use. These technologies have the potential to build on existing recruitment methods, provide new and improved intervention methods, and introduce novel ways of monitoring and predicting new HIV cases. However, little work has been done to review and broadly explore the types of studies being conducted on the use of technologies to address HIV and substance use. This systematic literature review identified studies on this topic between 2005 and 2015. We identified 33 studies on this topic after excluding studies that did not fit inclusion criteria. Studies were either observational (n = 24) or interventional (n = 9), with the majority being pilot studies exploring the feasibility of using these new technologies to study HIV and substance use. We discuss the implications of this work along with limitations and recommendations for future research on this topic.
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Affiliation(s)
- Sean D Young
- UCLA Department of Family Medicine, University of California Institute for Prediction Technology, 10880 Wilshire Blvd Suite 1800, Los Angeles, CA, 90049, USA.
| | - Dallas Swendeman
- UCLA Department of Psychiatry and Biobehavioral Sciences, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
| | - Ian W Holloway
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, CA, USA
| | - Cathy J Reback
- Friends Research Institute, Inc., David Geffen School of Medicine, Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Uyen Kao
- UCLA Department of Family Medicine, UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
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Novel Approaches for Visualizing and Analyzing Dose-Timing Data from Electronic Drug Monitors, or "How the 'Broken Window' Theory Pertains to ART Adherence". AIDS Behav 2015; 19:2057-68. [PMID: 25893658 DOI: 10.1007/s10461-015-1065-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adherence to antiretroviral medications is usually expressed in terms of the proportion of doses taken. However, the timing of doses taken may also be an important dimension to overall adherence. Little is known about whether patients who mistime doses are also more likely to skip doses. Using data from the completed Adherence for Life randomized controlled trial, we created visual and statistical models to capture and analyze dose timing data collected longitudinally with electronic drug monitors (EDM). From scatter plots depicting dose time versus calendar date, we identified dominant patterns of dose taking and calculated key features [slope of line over calendar date; residual mean standard error (RMSE)]. Each was assessed for its ability to categorize subjects with 'sub-optimal' (<95 % of doses taken) using area under the receiver operating characteristic (AROC) curve analysis. Sixty eight subjects contributed EDM data, with ~300 to 400 observations/subject. While regression line slopes did not predict 'sub-optimal' adherence (AROC 0.51, 95 % CI 0.26-0.75), the variability in dose timing (RMSE) was strongly predictive (AROC 0.79, 95 % CI 0.62-0.97). Compared with the lowest quartile of RMSE (minimal dose time variability), each successive quartile roughly doubled the odds of 'sub-optimal' adherence (OR 2.1, 95 % CI 1.3-3.4). Patterns of dose timing and mistiming are strongly related to overall adherence behavior. Notably, individuals who skip doses are more likely to mistime doses, with the degree of risk positively correlated with the extent of dose timing variability.
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40
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Feelemyer J, Des Jarlais D, Arasteh K, Uusküla A. Adherence to antiretroviral medications among persons who inject drugs in transitional, low and middle income countries: an international systematic review. AIDS Behav 2015; 19:575-83. [PMID: 25331268 DOI: 10.1007/s10461-014-0928-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adherence to antiretroviral (ART) medication is vital to reducing morbidity and mortality among HIV positive persons. People who inject drugs (PWID) are at high risk for HIV infection in transitional/low/middle income countries (TLMIC). We conducted a systematic review of studies reporting adherence to ART among persons with active injection drug use and/or histories of injection drug use in TLMIC. Meta-regression was performed to examine relationships between location, adherence measurements, and follow-up period. Fifteen studies were included from seven countries. Adherence levels ranged from 33 to 97 %; mean weighted adherence was 72 %. ART adherence was associated with different methods of measuring adherence and studies conducted in Eastern Europe and East Asia. The great heterogeneity observed precludes generalization to TLMIC as a whole. Given the critical importance of ART adherence more research is needed on ART adherence among PWID in TLMIC, including the use of standardized methods for reporting adherence to ART.
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Affiliation(s)
- Jonathan Feelemyer
- The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, 160 Water Street, New York, NY, 10038, USA,
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Real-time medication adherence monitoring intervention: test of concept in people living with HIV infection. J Assoc Nurses AIDS Care 2014; 25:646-51. [PMID: 25043931 DOI: 10.1016/j.jana.2014.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/13/2014] [Indexed: 11/20/2022]
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Lankowski AJ, Siedner MJ, Bangsberg DR, Tsai AC. Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review. AIDS Behav 2014; 18:1199-223. [PMID: 24563115 DOI: 10.1007/s10461-014-0729-8] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Difficulty obtaining reliable transportation to clinic is frequently cited as a barrier to HIV care in sub-Saharan Africa (SSA). Numerous studies have sought to characterize the impact of geographic and transportation-related barriers on HIV outcomes in SSA, but to date there has been no systematic attempt to summarize these findings. In this systematic review, we summarized this body of literature. We searched for studies conducted in SSA examining the following outcomes in the HIV care continuum: (1) voluntary counseling and testing, (2) pre-antiretroviral therapy (ART) linkage to care, (3) loss to follow-up and mortality, and (4) ART adherence and/or viral suppression. We identified 34 studies containing 52 unique estimates of association between a geographic or transportation-related barrier and an HIV outcome. There was an inverse effect in 23 estimates (44 %), a null association in 26 (50 %), and a paradoxical beneficial impact in 3 (6 %). We conclude that geographic and transportation-related barriers are associated with poor outcomes across the continuum of HIV care.
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