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Feasibility Study of the Disease Management Assistance System: A Potential Adherence Enhancing Device A. ANDRADE*1, A. WU1, O. SELNES1, C. HILL1, A. LETZT2, R. SEIFERT2, D. KASEMAN2, W. MYERS2, J. LEFKOWITZ2, and J. C. MCARTHUR1.
1The Johns Hopkins Univ., Baltimore, MD, and 2Adherence Technologies Corp., Burke, VA Background: Failure to remember to take antiretrovirals (ARVs) has been identified as a major barrier to adequate adherence. This is even of greater concern among patients who have HIV dementia (HIV-D). We conducted an 8-week pilot study to test the feasibility of a novel electronic device designed to enhance adherence to ARVs.
Methods: Twenty-five HIV+ patients, on a variety of ARV regimes, were provided with the DMAS, which was programmed to provide a verbal reminder to take ARVs at set times, and verbal counseling.
Results: Of the 25 patients enrolled, 19 completed the pilot study. Twelve were males; their mean age was 42; 80% were African American, and their mean education level was 12th grade. Patients were taking between 2 and 5 ARVs. Four subjects were characterized as having moderate HIV-D. Adherence scores (AS) ranged from 73–100% (mean 91%±9.1%) during the first 2 weeks and 0–100% (mean 81%±31.1%) during the last 2 weeks. In the group with AS >96%, 2 had dementia, 5 had depression, and 1 was hospitalized. Potential contributors to "poor" adherence were identified. Those with AS <90% were more likely to be hospitalized. Neither dementia nor depression influenced AS. 2/4 patients with HIV-D maintained AS >95% during the first and last 4 weeks of the study, while two others had a slight decrease in AS during the same period (96–88%, and 66–56%). Both of these patients were hospitalized during the study. On a 10-point Likert scale for ease of use, 18 of 19 patients rated DMAS 10.
Conclusion: DMAS was well accepted among all subjects, including those with HIV-dementia. AS were >96% in half of the patients. Lower AS were generally associated with greater patient morbidity. Based on these results we plan an intervention trial to compare DMAS with standard adherence-enhancing techniques.
Key Words: adherence, device, HIV-dementia
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