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A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects

Adriana S A Andrade1, Henraya F McGruder, Albert W Wu

  • 1Division of Infectious Diseases, Department of Medicine, The Johns Hopkins University, School of Medicine, Baltimore, Maryland 21205, USA. aandrade@jhmi.edu

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|August 19, 2005
PubMed

Insights

A memory-prompting device improved highly active antiretroviral therapy (HAART) adherence in HIV-infected individuals with memory impairments. The Disease Management Assistance System (DMAS) did not significantly improve adherence in memory-intact patients.

Area of Science:

  • Infectious Diseases
  • Neuroscience
  • Public Health

Background:

  • Patient nonadherence to highly active antiretroviral therapy (HAART) is a significant challenge in managing HIV infection.
  • Forgetfulness is frequently cited as a primary reason for medication nonadherence.
  • Assessing adherence interventions is crucial for improving treatment outcomes in human immunodeficiency virus (HIV)-infected individuals.

Purpose of the Study:

  • To evaluate the efficacy of a memory-prompting device, the Disease Management Assistance System (DMAS), in improving HAART adherence.
  • To compare the impact of the DMAS on adherence in HIV-infected subjects with and without memory impairments.
  • To determine if DMAS use influences virological and immunological responses in HIV patients.

Main Methods:

  • A prospective, randomized, controlled trial was conducted with 64 HIV-infected adults.
  • The intervention group used the DMAS device, which provided verbal reminders, alongside monthly adherence counseling.
  • The control group received only monthly adherence counseling. Adherence was measured using electronic drug exposure monitor (eDEM) caps over 24 weeks.

Main Results:

  • Overall adherence did not significantly differ between DMAS users (80%) and control subjects (65%).
  • Memory-impaired subjects using DMAS showed significantly higher adherence (77%) compared to controls (57%) (P=.001).
  • Memory-intact subjects did not demonstrate a significant adherence improvement with DMAS use (83% vs. 77%, P=.25).

Conclusions:

  • The DMAS prompting device effectively improved HAART adherence in HIV-infected individuals with memory impairments.
  • The DMAS did not significantly enhance adherence in HIV-infected individuals with intact memory.
  • While DMAS use was associated with higher undetectable HIV RNA loads at 12 weeks in the overall group, this effect diminished by 24 weeks.

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