We collected data on feasibility and acceptability of a real-time web-linked adherence monitoring container among HIV-positive injection drug users (IDU) in China. “Wisepill” uses wireless technology to track on-time medication dosing. Ten patients on antiretroviral therapy (ART) at the Guangxi CDC HIV clinic in Nanning, China, used Wisepill for one ART medication for one month. We monitored device use and adherence and explored acceptability of the device among patients. Mean adherence was 89.2% (SD 10.6%). Half of the subjects reported a positive overall experience with Wisepill. Seven said that it was inconvenient, supported by comments that it was large and conspicuous. Five worried about disclosure of HIV status due to the device; no disclosures were reported. Twelve signal lapses occurred (5.4% of prescribed doses), of which one was due to technical reasons, nine to behavioral reasons (both intentional and unintentional), and two to unclear reasons. Although the technical components must be monitored carefully, and acceptability to patients presents challenges which warrant further exploration, the Wisepill device has potential for adherence interventions that deliver rapid adherence-support behavioral feedback directly to patients, including IDU. The use of wireless technology appears uniquely promising for providing time-sensitive communication on patient behavior that can be harnessed to maximize the benefits of HIV treatment. 1. Introduction Interventions to improve adherence to antiretroviral therapy (ART) are urgently needed among HIV-positive patients, particularly in developing countries, where most of the world’s HIV-infected population lives. China has experienced a major HIV/AIDS epidemic since the 1990s, with an estimated 780,000 persons living with HIV in 2011 [1]. Free ART is available nationwide and over 126,000 Chinese patients are now on treatment. However, few ART adherence studies have been conducted in China. As it is elsewhere in the world, ART adherence is suboptimal in China in large part because HIV/AIDS is highly stigmatized [2, 3]. Recently, wireless technology has emerged as a potential tool for monitoring medication adherence in real time [4–8]. This is noteworthy given the recognized association between late dose-timing and loss of viral suppression [9]. One promising tool, the Wisepill personal medication container (Wisepill Technologies, Cape Town, South Africa), detects the exact date and time whenever the patient opens it to access medication. It then transmits a real-time signal by general packet radio service
References
[1]
Ministry of Health and People's Republic of China, 2012 China AIDS Response Progress, Ministry of Health and People's Republic of China, Beijing, China, 2012.
[2]
H. Wang, G. He, X. Li et al., “Self-reported adherence to antiretroviral treatment among HIV-infected people in Central China,” AIDS Patient Care and STDs, vol. 22, no. 1, pp. 71–80, 2008.
[3]
L. L. Sabin, M. B. DeSilva, D. H. Hamer et al., “Barriers to adherence to antiretroviral medications among patients living with HIV in southern China: a qualitative study,” AIDS Care, vol. 20, no. 10, pp. 1242–1250, 2008.
[4]
K. E. Charlton, L. T. Bourne, K. Steyn, and J. A. Laubscher, “Poor nutritional status in older black South Africans,” Asia Pacific Journal of Clinical Nutrition, vol. 10, no. 1, pp. 31–38, 2001.
[5]
T. Horvath, H. Azman, G. E. Kennedy, and G. W. Rutherford, “Mobile phone text messaging for promoting adherence to antiretroviral therapy in patients with HIV infection,” Cochrane Database of Systematic Reviews, vol. 3, Article ID CD009756, 2012.
[6]
B. X. Tran and S. Houston, “Mobile phone-based antiretroviral adherence support in Vietnam: feasibility, patient's preference, and willingness-to-pay,” AIDS and Behavior, vol. 16, no. 7, pp. 1988–1992, 2012.
[7]
R. Rodrigues, A. Shet, J. Antony et al., “Supporting adherence to antiretroviral therapy with mobile phone reminders: results from a cohort in South India,” PLoS ONE, vol. 7, no. 8, Article ID e40723, 2012.
[8]
M. L. Scanlon and R. C. Vreeman, “Current strategies for improving access and adherence to antiretroviral therapies in resource-limited settings,” HIV AIDS, vol. 5, pp. 1–17, 2013.
[9]
J. Parienti, M. Das-Douglas, V. Massari et al., “Not all missed doses are the same: sustained NNRTI treatment interruptions predict HIV rebound at low-to-moderate adherence levels,” PLoS ONE, vol. 3, no. 7, Article ID e2783, 2008.
[10]
J. M. Boyce, T. Cooper, and M. J. Dolan, “Evaluation of an electronic device for real-time measurement of alcohol-based hand rub use,” Infection Control and Hospital Epidemiology, vol. 30, no. 11, pp. 1090–1095, 2009.
[11]
M. F. Walji, O. Coker, J. A. Valenza, H. Henson, D. Warren-Morris, and L. Zhong, “A persuasive toothbrush to enhance oral hygiene adherence,” AMIA Annual Symposium Proceedings, p. 1167, 2008.
[12]
J. E. Haberer, J. Kahane, I. Kigozi et al., “Real-time adherence monitoring for HIV antiretroviral therapy,” AIDS and Behavior, vol. 14, no. 6, pp. 1340–1346, 2010.
[13]
M. J. Siedner, A. Lankowski, D. Musinga et al., “Optimizing network connectivity for mobile health technologies in sub-Saharan Africa,” PLoS ONE, vol. 7, no. 9, Article ID e45643, 2012.
[14]
L. L. Sabin, M. B. DeSilva, D. H. Hamer et al., “Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China,” AIDS and Behavior, vol. 14, no. 3, pp. 580–589, 2010.
[15]
M. N. Burns, M. Begale, J. Duffecy et al., “Harnessing context sensing to develop a mobile intervention for depression,” Journal of Medical Internet Research, vol. 13, no. 3, p. e55, 2011.
[16]
C. J. Gill, L. L. Sabin, D. H. Hamer et al., “Importance of dose timing to achieving undetectable viral loads,” AIDS and Behavior, vol. 14, no. 4, pp. 785–793, 2010.
