Electronic medication monitoring-informed counseling to improve adherence to combination anti-retroviral therapy and virologic treatment outcomes: a meta-analysis

Nienke Langebeek, Pythia Nieuwkerk, Nienke Langebeek, Pythia Nieuwkerk

Abstract

Background: Adherence to combination anti-retroviral therapy for HIV infection is a primary determinant of treatment success, but is often suboptimal. Previous studies have suggested that electronic medication monitoring-informed counseling is among the most effective adherence intervention components. Our objective was to review available evidence about the effectiveness of monitoring-informed counseling and to aggregate findings into quantitative estimates of the effect of such intervention on medication adherence and virologic treatment outcomes.

Methods: We searched PubMed for papers reporting on randomized controlled trials comparing intervention groups receiving monitoring-informed counseling as one of the intervention components versus control groups not receiving such counseling for their effect on medication adherence and viral load concentrations. The standardized mean difference (SMD) in adherence and the odds ratio (OR) of undetectable HIV RNA in intervention versus control groups were the common effect sizes. Random-effect models with inverse variance weights were used to aggregate findings into pooled effect estimates with 95% confidence limits (CI).

Results: A total of 13 studies were included. Adherence was significantly higher in intervention groups than in control groups (SMD 0.51, 95% CI 0.31-0.71). Patients in intervention groups were significantly more likely to have undetectable HIV RNA concentrations than patients in control groups (OR 1.35, 95% CI 1.12-1.63). However, in studies in which monitoring-informed counseling was the only intervention component, the difference in adherence and virologic response between intervention and control groups was not statistically significant.

Conclusion: Electronic monitoring-informed counseling improved adherence and virologic response compared with control groups not receiving such counseling in studies in which it was one out of multiple intervention components, but not in studies where it was the only intervention component.

Keywords: HIV infection; adherence; anti-retroviral therapy; compliance; meta-analysis.

Figures

Figure 1
Figure 1
Flow diagram.
Figure 2
Figure 2
Effect of interventions on adherence.
Figure 3
Figure 3
Effect of interventions on the likelihood of undetectable HIV RNA.
Figure 4
Figure 4
Meta-regression of number of intervention components on the log odds of undetectable HIV RNA.
Figure 5
Figure 5
Funnel plot medication adherence.
Figure 6
Figure 6
Funnel plot undetectable HIV RNA.

References

    1. Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS (2001) 5:1181–310.1097/00002030-200106150-00015
    1. Nachega JB, Hislop M, Dowdy DW, Chaisson RE, Regensberg L, Maartens G. Adherence to nonnucleoside reverse transcriptase inhibitor based HIV therapy and virologic outcomes. Ann Intern Med (2007) 146:564–7310.7326/0003-4819-146-8-200704170-00007
    1. Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JS. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350×10(9) cells/L. Ann Intern Med (2003) 139:810–6.10.7326/0003-4819-139-10-200311180-00008
    1. Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodríguez E, et al. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav (2011) 15:1381–96.10.1007/s10461-011-9942-x
    1. Amico KR, Harman JJ, Johnson BT. Efficacy of antiretroviral therapy adherence interventions: a research synthesis of trials, 1996 to 2004. J Acquir Immune Defic Syndr (2006) 41:285–97.10.1097/01.qai.0000197870.99196.ea
    1. Simoni JM, Pearson CR, Pantalone DW, Marks G, Crepaz N. Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. J Acquir Immune Defic Syndr (2006) 43(Suppl 1):S23–35.10.1097/01.qai.0000248342.05438.52
    1. Mathes T, Pieper D, Antoine SL, Eikermann M. Adherence-enhancing interventions for highly active antiretroviral therapy in HIV-infected patients – a systematic review. HIV Med (2013) 14:583–95.10.1111/hiv.12051
    1. Chaiyachati KH, Ogbuoji O, Price M, Suthar AB, Negussie EK, Bärnighausen T. Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. AIDS (2014) 28(Suppl 2):S187–204.10.1097/QAD.0000000000000252
    1. Kripalani S, Yao X, Haynes RB. Interventions to enhance medication adherence in chronic medical conditions: a systematic review. Arch Intern Med (2007) 167:540–50.10.1001/archinte.167.6.540
    1. Demonceau J, Ruppar T, Kristanto P, Hughes DA, Fargher E, Kardas P, et al. ABC project team. Identification and assessment of adherence-enhancing interventions in studies assessing medication adherence through electronically compiled drug dosing histories: a systematic literature review and meta-analysis. Drugs (2013) 73:545–62.10.1007/s40265-013-0041-3
    1. Marcus JL, Buisker T, Horvath T, Amico KR, Fuchs JD, Buchbinder SP, et al. Helping our patients take HIV pre-exposure prophylaxis (PrEP): a systematic review of adherence interventions. HIV Med (2014) 15:385–95.10.1111/hiv.12132
    1. de Bruin M, Hospers HJ, van Breukelen GJP, Kok G, Koevoets WM, Prins JM. Electronic monitoring-based counselling to enhance adherence among HIV-infected patients: a randomized controlled trial. Health Psychol (2010) 29:421–8.10.1037/a0020335
    1. Wilson IB, Laws MB, Safren SA, Lee Y, Lu M, Coady W, et al. Provider-focused intervention increases adherence-related dialogue but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr (2010) 53:338–47.10.1097/QAI.0b013e3181c7a245
    1. Lipsey MW, Wilson DB. Practical Meta-Analysis. Thousand Oaks, CA: Sage; (2001).
    1. Cohen J. Statistical Power Analysis for the Behavioural Sciences. Mahwah, NJ: Erlbaum; (1988).
    1. Wilson DB. Meta-Analysis Macros for SPSS (Version 2005.05.23). Available from:
    1. Davies S, Asghar S, Cooper V, Lange A, Robertson C, Vrijens B, et al. Does feedback of medication execution using MEMS cap aid adherence to HAART?: the MEMRI study (MEMS as realistic intervention). J Int AIDS Soc (2010) 13(Suppl 4):120.10.1186/1758-2652-13-S4-P120
    1. Engelbrecht CJ. The Impact of an Electronic Medication Monitoring System on the Adherence of Patients to Antiretroviral Medication at the Tshepang Clinic, Dr George Mukhari Hospital. University of Limpopo (Medunsa Campus) (2010). Available from:
    1. Gross R, Belamy SL, Chapman J, Han X, O’Duor J, Palmer SC, et al. Managed problem solving for antiretroviral therapy adherence. JAMA Intern Med (2013) 4:300–6.10.1001/jamainternmed.2013.2152
    1. Koenig LJ, Pals SL, Bush T, Pratt Palmore M, Stratford D, Ellerbrock TV. Randomized controlled trial of an intervention to prevent adherence failure among HIV-infected patients initiating antiretroviral therapy. Health Psychol (2008) 27:159–69.10.1037/0278-6133.27.2.159
    1. Davies G, Koenig LJ, Stratford D, Palmore M, Bush T, Golde M, et al. Overview and implementation of an intervention to prevent adherence failure among HIV-infected adults initiating antiretroviral therapy: lessons learned from project HEART. AIDS Care (2006) 18:895–903.10.1080/09540120500329556
    1. Rigsby MO, Rosen MI, Beauvais JE, Cramer JA, Rainey PM, O’Malley SS, et al. Cue-dose training with monetary reinforcement. Pilot study of an adherence intervention. J Gen Intern Med (2000) 15:841–7.10.1046/j.1525-1497.2000.00127.x
    1. Rosen MI, Rigsby MO, Salahi JT, Ryan CE, Cramer JA. Electronic monitoring and counselling to improve medication adherence. Behav Res Ther (2004) 42:409–22.10.1016/S0005-7967(03)00149-9
    1. Sabin LL, DeSilva M, Hamer DH, Xu K, Zhang J, Li T, et al. Using electronic drug monitor feedback to improve adherence to antiretroviral therapy among HIV-positive patients in China. AIDS Behav (2010) 14:580–9.10.1007/s10461-009-9615-1
    1. Sabin L, Bachman DeSilva M, Zhong L, et al. The China adherence through technology study: the effect of real-time feedback on adherence to antiretroviral therapy. 9th International Conference on HIV Treatment and Prevention Adherence Miami, FL: (2014). Abstract 493.
    1. Safren SA, O’Cleirigh C, Tan JY, Raminani SR, Reilly LC, Otto MW, et al. A randomized controlled trial of cognitive behavioral therapy for adherence and depression (CBT-AD) in HIV-infected individuals. Health Psychol (2009) 28:1–1010.1037/a0012715
    1. Smith SR, Rublein JC, Marcus C, Brock P, Chesney MA. A medication self-management program to improve adherence to HIV therapy regimens. Patient Educ Couns (2003) 50:187–99.10.1016/S0738-3991(02)00127-1
    1. Wagner GJ, Kanouse DE, Golinelli D, Miller LG, Daar ES, Witt MD, et al. Cognitive-behavioural intervention to enhance adherence to antiretorviral therapy: a randomized controlled trial (CCTG 578). AIDS (2006) 20:1295–302.10.1097/01.aids.0000232238.28415.d2
    1. Simoni JM, Amico KR, Smith L, Nelson K. Antiretroviral adherence interventions: translating research findings to the real world clinic. Curr HIV/AIDS Rep (2010) 7(1):44–51.10.1007/s11904-009-0037-5
    1. Nieuwlaat R, Wilczynski N, Navarro T, Hobson N, Jeffery R, Keepanasseril A, et al. Interventions for enhancing medication adherence. Cochrane Database Syst Rev (2014) 11:CD000011.10.1002/14651858.CD000011.pub4
    1. Marcum ZA, Sevick MA, Handler SM. Medication nonadherence: a diagnosable and treatable medical condition. JAMA (2013) 309:2105–610.1001/jama.2013.4638
    1. de Bruin M, Viechtbauer W, Schaalma HP, Kok G, Abraham C, Hospers HJ. Standard care impact on effects of highly active antiretorviral therapy adherence interventions. Arch Intern Med (2010) 170:240–50.10.1001/archinternmed.2009.536

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