Electronic Monitoring Pillboxes Effective in Monitoring Antiretroviral Adherence in Low-Technology Contexts
August 17, 2016
After years of research and testing, a method for monitoring medication adherence in real-time has proven effective in low-resource settings, attendees heard at the AIDS 2016 workshop, "Measuring Antiretroviral Therapy Adherence: Using Real-Time Adherence Monitoring in Research and Practice." Electronic monitoring devices are now being used in research studies to assess when antiretrovirals are taken. According to doctors who have participated in such studies, this type of monitoring is one of the more objective adherence measures.
Wisepill, created by a South African company, is a small pill container that records the date and time it is opened and uses mobile networks to transmit that information to a secure server. This allows researchers or medical providers to check usage reports. Even if a patient is outside of network coverage for a period, once the device is back online the recorded information will be immediately sent to the server. Researchers can also log into the server and run reports on the battery life of devices to avoid disruptions in data collection. Additionally, SMS reminders can be sent to patients or their caregivers. The reminder system doesn't work like an alarm clock to remind people to take their pills, but is instead activated only if a scheduled dose time is missed.
Since the devices are primarily being used in parts of the world where new technology is not widely available, the device was kept simple and basic in appearance to discourage patients from trying to exchange it for money. Reuben Robbins, Ph.D., of Columbia University and the New York State Psychiatric Institute said, "Overall, in our work, we found that it's very highly acceptable and some like the fact that it sort of looks like a cell phone." According to Robbins, people have found that it helps with stigma because it doesn't look like a pillbox.
Robbins said that the devices could be reused, but need proper maintenance. Additionally, staff are needed to monitor all the reports generated. Finally, he noted that "pocket dosing" is a problem that must be taken into consideration as "the device only monitors when the box is opened, not when the pills are ingested."
Claude Ann Mellins, Ph.D., of Columbia University and New York State Psychiatric Institute was part of a two-year family-based economic empowerment intervention in Uganda to promote antiretroviral adherence, mental health and economic stability. The study involved 702 HIV-positive children aged 10-16. Wisepill was used to monitor adherence for three-plus years with 500 active devices. She said "it was highly acceptable," but emphasized that, "in Uganda, many of the homes lack electricity, so many of the devices need to be charged at a research office, as some of the clinics don't have electricity either." To assist with this problem and to allow general inspection of the devices, participants were asked to bring their devices each time they came for a scheduled visit.
Wisepill is currently in distribution and available in different world markets. Presenters noted that many countries have unique shipping laws and, due to the device's cellular technology, restrictions could impact its transit through international customs.
Presenters said that the device had proven effective in many studies in developing countries; however, its benefits in studies in more developed countries such as the United States were not yet clear.
David Duran is a freelance journalist and writer based in Brooklyn, N.Y. Follow David on Twitter: @mrdavidduran.
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