Effect of Digital Adherence Tools on Adherence to Antiretroviral Treatment Among Adults Living With HIV in Kilimanjaro, Tanzania: A Randomized Controlled Trial
Sumari-de Boer IM, Ngowi, KM, Sonda TB, Pima FM, Masika LV, Sprangers MAG, Reiss P, Mmbaga BT, Nieuwkerk PT, Aarnoutse RE. (2021). Effect of Digital Adherence Tools on Adherence to Antiretroviral Treatment Among Adults Living With HIV in Kilimanjaro, Tanzania: A Randomized Controlled Trial. JAIDS Journal of Acquired Immune Deficiency Syndromes, 87:5, 1136-1144, doi: 10.1097/QAI.0000000000002695
This study investigated two digital antiretroviral HIV treatment adherence interventions among adults with suboptimal adherence living in Kilimanjaro, Tanzania using a parallel 3-arm, non-blinded, randomized controlled trial with 1:1:1 allocation. In one arm, 80 participants received reminder text messages (SMS) on 3 random days a week. In the second arm, 82 participants received a real-time medication monitoring device (RTMM) called Wisepill with SMS reminders. The device contains antiretroviral treatment, and each opening is registered and sent to an Internet server. If participants do not open before the end of the dosage window, a text reminder is sent. In the third arm, 81 participants received treatment as usual according to Tanzanian guidelines (minimal adherence counseling by nurses or pharmacists and annual viral load test). Proportion of participants who have sufficient treatment adherence (>85% of doses) was collected at enrollment and every 8 weeks for 48 weeks (total of 7 timepoints) using pharmacy refill counts and self-report. Over 48 weeks, no significant difference in self-reported adherence was found between the three arms. The average adherence based on pharmacy refills was also not significantly different across the three arms. None of the intervention arms showed a significant effect on viral suppression rates. Overall, the study’s findings do not support the use of RTMM or SMS reminder cues as a means to significantly improve adherence to HIV treatment. The difference in pharmacy refill counts compared to self-reported adherence might be due to social desirability and overreporting in all arms. More research is needed to explore how digital interventions can be used to optimize adherence across risk groups, including children, youth, and pregnant or breastfeeding women.