Sabin Lora L, Bachman DeSilva Mary, Gill Christopher J, Zhong Li, Vian Taryn, Xie Wubin, Cheng Feng, Xu Keyi, Lan Guanghua, Haberer Jessica E, Bangsberg David R, Li Yongzhen, Lu Hongyan, Gifford Allen L
*Center for Global Health and Development, Boston University, Boston, MA; †Department of Global Health, Boston University School of Public Health, Boston, MA; ‡FHI 360, Beijing, China; §Research Center for Public Health (TPHRC), School of Medicine, Tsinghua University, Beijing, China; ‖WHO Collaborating Center for Comprehensive Management of HIV Treatment and Care, Ditan Hospital, Beijing, China; ¶AIDS Division, Guangxi Centers for Disease Control and Prevention, Nanning, China; #Center for Global Health, Massachusetts General Hospital, Boston, MA; **Department of Health Policy and Management, Boston University School of Public Health, Boston, MA; and ††Edith Nourse Rogers Memorial VA Hospital, Bedford, MA.
J Acquir Immune Defic Syndr. 2015 Aug 15;69(5):551-9. doi: 10.1097/QAI.0000000000000651.
BACKGROUND: Real-time adherence monitoring is now possible through medication storage devices equipped with cellular technology. We assessed the effect of triggered cell phone reminders and counseling using objective adherence data on antiretroviral therapy (ART) adherence among Chinese HIV-infected patients. METHODS: We provided ART patients in Nanning, China, with a medication device (Wisepill) to monitor their ART adherence electronically. After 3 months, we randomized subjects within optimal (≥95%) and suboptimal (<95%) adherence strata to intervention vs. control arms. In months 4-9, intervention subjects received individualized reminders triggered by late dose taking (no device opening by 30 minutes past dose time) and counseling using device-generated data. Controls received no reminders or data-informed counseling. We compared postintervention proportions achieving optimal adherence, mean adherence, and clinical outcomes. RESULTS: Of 120 subjects enrolled, 116 (96.7%) completed the trial. Preintervention optimal adherence was similar in intervention vs. control arms (63.5% vs. 58.9%, respectively; P = 0.60). In the last intervention month, 87.3% vs. 51.8% achieved optimal adherence [risk ratio (RR): 1.7, 95% confidence interval (CI): 1.3 to 2.2] and mean adherence was 96.2% vs. 89.1% (P = 0.003). Among preintervention suboptimal adherers, 78.3% vs. 33.3% (RR: 2.4, CI: 1.2 to 4.5) achieved optimal adherence and mean adherence was 93.3% vs. 84.7% (P = 0.039). Proportions were 92.5% and 62.9% among optimal adherers, respectively (RR: 1.5, CI: 1.1 to 1.9) and mean adherence was 97.8% vs. 91.7% (P = 0.028). Postintervention clinical outcomes were not significant. CONCLUSIONS: Real-time reminders significantly improved ART adherence in this population. This approach seems promising for managing HIV and other chronic diseases and warrants further investigation and adaptation in other settings.
背景：通过配备蜂窝技术的药物储存设备，现在可以进行实时依从性监测。我们使用客观的依从性数据评估了触发式手机提醒和咨询对中国艾滋病毒感染患者抗逆转录病毒疗法（ART）依从性的影响。 方法：我们为中国南宁的接受抗逆转录病毒治疗的患者提供了一种药物设备（Wisepill），以电子方式监测他们的抗逆转录病毒治疗依从性。3个月后，我们将最佳依从性（≥95%）和次优依从性（<95%）分层内的受试者随机分为干预组和对照组。在第4至9个月，干预组受试者收到因服药延迟（服药时间过后30分钟未打开设备）触发的个性化提醒，并使用设备生成的数据进行咨询。对照组未收到提醒或基于数据的咨询。我们比较了干预后达到最佳依从性的比例、平均依从性和临床结果。 结果：在纳入的120名受试者中，116名（96.7%）完成了试验。干预组和对照组干预前的最佳依从性相似（分别为63.5%和58.9%；P = 0.60）。在最后一个干预月，达到最佳依从性的比例分别为87.3%和51.8%[风险比（RR）：1.7，95%置信区间（CI）：1.3至2.2]，平均依从性分别为96.2%和89.1%（P = 0.003）。在干预前依从性次优的受试者中，达到最佳依从性的比例分别为78.3%和33.3%（RR：2.4，CI：1.2至4.5），平均依从性分别为93.3%和84.7%（P = 0.039）。在最佳依从性的受试者中，这一比例分别为92.5%和62.9%（RR：1.5，CI：1.1至1.9），平均依从性分别为97.8%和91.7%（P = 0.028）。干预后的临床结果无显著差异。 结论：实时提醒显著提高了该人群的抗逆转录病毒治疗依从性。这种方法对于管理艾滋病毒和其他慢性病似乎很有前景，值得在其他环境中进一步研究和应用。
J Acquir Immune Defic Syndr. 2015-8-15
J Acquir Immune Defic Syndr. 2016-9-1
J Acquir Immune Defic Syndr. 2016-10-1
Cureus. 2024-9-21
J Patient Rep Outcomes. 2024-1-23
Res Social Adm Pharm. 2014
Zotero 插件