The Effect of Real-Time Medication Monitoring-Based Digital Adherence Tools on Adherence to Antiretroviral Therapy and Viral Suppression in People Living With HIV: A Systematic Literature Review and Meta-Analysis

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Abstract

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Abstract

Background:

Universal antiretroviral therapy (ART) has led to improved treatment outcomes in persons living with HIV. Adherence to ART is required to achieve viral suppression. Real-time medication monitoring (RTMM)–based digital adherence tools (DATs) could be effective in improving ART adherence and viral suppression in persons living with HIV.

Objectives:

The primary and secondary objectives of this review were to assess the effect of RTMM-based DATs on improving ART adherence and viral load suppression.

Methods:

We searched MEDLINE, Embase, and Global Health for publications published through October 11, 2022. Narrative synthesis and random effects meta-analyses were conducted to synthesize the results.

Results:

Of 638 papers identified, 8 were included. Six studies were randomized controlled trials (RCTs), and 2 were cohort studies. Two studies, an RCT in China (mean adherence: 96.2% vs 89.1%) and a crossover cohort study in Uganda (mean adherence: 84% vs 93%), demonstrated improved ART adherence. No studies demonstrated improved viral suppression. In the meta-analyses, we estimated that RTMM-based digital adherence tools had a statistically insignificant small positive effect on ART adherence and viral suppression with a standardized mean difference of 0.1922 [95% CI: −0.0268 to 0.4112, P-value: 0.0854] and viral suppression with an odds ratio of 1.3148 [95% CI: 0.9199 to 1.8791, P-value: 0.1331].

Conclusions:

Our meta-analyses found that RTMM-based DATs did not have a significant effect on ART adherence and viral suppression. However, due to few published studies available, heterogeneity of target populations, intervention designs, and adherence measurement instruments, more data are required to provide conclusive evidence.

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Most cited references 37

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RoB 2: a revised tool for assessing risk of bias in randomised trials

Jonathan A C Sterne, Jelena Savović, Matthew J L Page … (2022)

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Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.

David L. Paterson, Susan Swindells, Jeffrey T. Mohr … (2000)

Combination antiretroviral therapy with protease inhibitors has transformed HIV infection from a terminal condition into one that is manageable. However, the complexity of regimens makes adherence to therapy difficult. To assess the effects of different levels of adherence to therapy on virologic, immunologic, and clinical outcome; to determine modifiable conditions associated with suboptimal adherence; and to determine how well clinicians predict patient adherence. Prospective, observational study. HIV clinics in a Veterans Affairs medical center and a university medical center. 99 HIV-infected patients who were prescribed a protease inhibitor and who neither used a medication organizer nor received their medications in an observed setting (such as a jail or nursing home). Adherence was measured by using a microelectronic monitoring system. The adherence rate was calculated as the number of doses taken divided by the number prescribed. Patients were followed for a median of 6 months (range, 3 to 15 months). During the study period, 45,397 doses of protease inhibitor were monitored in 81 evaluable patients. Adherence was significantly associated with successful virologic outcome (P < 0.001) and increase in CD4 lymphocyte count (P = 0.006). Virologic failure was documented in 22% of patients with adherence of 95% or greater, 61% of those with 80% to 94.9% adherence, and 80% of those with less than 80% adherence. Patients with adherence of 95% or greater had fewer days in the hospital (2.6 days per 1000 days of follow-up) than those with less than 95% adherence (12.9 days per 1000 days of follow-up; P = 0.001). No opportunistic infections or deaths occurred in patients with 95% or greater adherence. Active psychiatric illness was an independent risk factor for adherence less than 95% (P = 0.04). Physicians predicted adherence incorrectly for 41% of patients, and clinic nurses predicted it incorrectly for 30% of patients. Adherence to protease inhibitor therapy of 95% or greater optimized virologic outcome for patients with HIV infection. Diagnosis and treatment of psychiatric illness should be further investigated as a means to improve adherence to therapy.

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Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

Kiran Jobanputra, Lucy Anne Parker, Charles Azih … (2015)

Introduction This study explores factors associated with virological detectability, and viral re-suppression after enhanced adherence counselling, in adults and children on antiretroviral therapy (ART) in Swaziland. Methods This descriptive study used laboratory data from 7/5/2012 to 30/9/2013, which were linked with the national ART database to provide information on time on ART and CD4 count; information on enhanced adherence counselling was obtained from file review in health facilities. Multivariable logistic regression was used to explore the relationship between viral load, gender, age, time on ART, CD4 count and receiving (or not receiving) enhanced adherence counselling. Results From 12,063 patients undergoing routine viral load monitoring, 1941 (16%) had detectable viral loads. Children were more likely to have detectable viral loads (AOR 2.6, 95%CI 1.5–4.5), as were adolescents (AOR 3.2, 95%CI 2.2–4.8), patients with last CD4 1000 copies/ml (AOR 0.3, 95%CI 0.1–0.7), and those with last CD4<350 cells/µl (AOR 0.4, 95%CI 0.2–0.7). Receiving (or not receiving) enhanced adherence counselling was not associated with likelihood of re-suppression. Conclusions Children, adolescents and those with advanced disease were most likely to have high viral loads and least likely to achieve viral suppression at retesting; receiving adherence counselling was not associated with higher likelihood of viral suppression. Although the level of viral resistance was not quantified, this study suggests the need for ART treatment support that addresses the adherence problems of younger people; and to define the elements of optimal enhanced adherence support for patients of all ages with detectable viral loads.

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Author and article information

Contributors

Iraseni Swai

Rob Aarnoutse

Tobias F. Rinke de Wit

Kennedy Ngowi

Chisomo Msefula

Marriott Nliwasa

Marion Sumari-de Boer

Journal

Journal ID (nlm-ta): J Acquir Immune Defic Syndr

Journal ID (iso-abbrev): J Acquir Immune Defic Syndr

Journal ID (publisher-id): qai

Title: Journal of Acquired Immune Deficiency Syndromes (1999)

Publisher: JAIDS Journal of Acquired Immune Deficiency Syndromes

ISSN (Print): 1525-4135

ISSN (Electronic): 1944-7884

Publication date (Print): 15 August 2024

Publication date (Electronic): 09 July 2024

Volume: 96

Issue: 5

Pages: 411-420

Affiliations

[a ]Department of Global Health, Amsterdam UMC, location University of Amsterdam, Amsterdam, the Netherlands;

[b ]Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands;

[c ]Helse Nord Tuberculosis Initiative, Kamuzu University of Health Sciences, Blantyre, Malawi;

[d ]Kilimanjaro Clinical Research Institute, Moshi, Tanzania;

[e ]Radboud University Medical Center, Department of Pharmacy, Research Institute for Medical Innovation, Nijmegen, the Netherlands; and

[f ]Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania.

Author notes

Correspondence to: Takondwa Charles Msosa, MBBS, Kamuzu University of Health Sciences, Blantyre Campus (Mahatma Gandhi Road), Private Bag 360, Blantyre, Malawi (e-mail: takondwamsosa@ 123456outlook.com ).

Author information

Takondwa Charles Msosa https://orcid.org/0000-0002-4375-5572

Article

Publisher ID: QAIV23461 Accession ID: 00001

DOI: 10.1097/QAI.0000000000003449

PMC ID: 11236270

PubMed ID: 38985562

SO-VID: c9500c28-a34c-47e5-8ed3-cb3167277480

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 01 November 2023

Date accepted : 19 April 2024

Funding

Funded by: European and Developing Countries Clinical Trials Partnership

Award ID: TMA2019SFP-2818

Award Recipient : Marion Sumari-de Boer

Funded by: Helse Nord Tuberculosis Initiative

Award Recipient : Marriott Nliwasa

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Keywords: hiv,viral load,art,adherence,real-time medication monitoring,digital,adherence tools

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Keywords: hiv, viral load, art, adherence, real-time medication monitoring, digital, adherence tools

The Effect of Real-Time Medication Monitoring-Based Digital Adherence Tools on Adherence to Antiretroviral Therapy and Viral Suppression in People Living With HIV: A Systematic Literature Review and Meta-Analysis

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Most cited references 37

RoB 2: a revised tool for assessing risk of bias in randomised trials

Adherence to protease inhibitor therapy and outcomes in patients with HIV infection.

Factors Associated with Virological Failure and Suppression after Enhanced Adherence Counselling, in Children, Adolescents and Adults on Antiretroviral Therapy for HIV in Swaziland

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