Technological Methods to Measure Adherence to Antiretroviral Therapy and Preexposure Prophylaxis

August 2017 - Combination Prevention

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Garrison, L.E., and Haberer, J.E. Current Opinion in HIV and AIDS (June 2017), 12:000–000, doi:10.1097/COH.0000000000000393.

This review summarized technologies for measuring adherence to antiretroviral treatment and pre-exposure prophylaxis (PrEP). The document includes:

  • Real-time electronic adherence monitors, including electronic pill boxes, bottles, and blister packs, record and send opening time and date information to a central server via cellular network. Benefits include facilitating immediate intervention and enabling risk assessment for viral rebound. Challenges include under- and overestimation of adherence due to non-use or openings out of curiosity.
  • Digital medicine systems comprise a sensor embedded within a pill that, when in contact with gastric acid, sends a message via Bluetooth® or radio frequency technology. No published data are available yet, though the technology has been deemed “moderately” acceptable in hypertension and schizophrenia studies.
  • Short message service surveys have been used to determine self-reported adherence and related behaviors including sexual activity and perceived risk to determine if PrEP is being used to its maximum benefit. Cell phone access, shared cell phones, reading ability, and confidentiality are concerns, but recent studies found high rates of feasibility and acceptability.
  • Pharmacokinetic measures quantify drug concentrations within various body tissues to measure drug concentrations. Feasibility, acceptability, and cost all present potential challenges to implementation.

The authors recommended considering these novel approaches in tandem with current evidence-informed approaches to measure adherence.

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