Twelfth Annual Grant Winners 2011-2012

Title: Evaluating the benefits of text message reminders on HIV medication adherence

Dean:
Andres Malave, PhD (HPD-PHR)

Faculty and Students:
Elizabeth Sherman, PharmD (HPD-PHR)
Kevin Clausen, PharmD (HPD-PHR)
Klumi Ayala, PharmD (HPD-PHR)

Abstract:

This study will document the impact of short message system (SMS) “text message” technology on medication adherence measures in HIV-infected patients. Mobile health technologies are quickly emerging as powerful tools for empowering patients to manage their own healthcare. The complex management of HIV provides a setting wherein medication adherence is tantamount to effective treatment. Without therapeutic intervention, HIV destroys immune cells, inviting opportunistic infections and cancers. Antiretroviral medications, by reducing viral replication (measured by HIV RNA), can preserve immunologic function, extend life expectancy, and improve quality of life. Poor medication adherence, however, is associated with diminished HIV RNA control, increased disease complications, development of resistant virus, increased HIV transmission, and higher cost burden. Frequently underlying suboptimal adherence is patients’ inability to recall and maintain dosage regimens. To overcome this stumbling block, SMS reminders will be used to encourage adherence. Health literacy also contributes to treatment success and its predictive potential on adherence will be examined. A randomized, controlled study enrolling 96 HIV-infected antiretroviral-naïve patients will be conducted at a primary care specialty clinic serving an ethnically diverse population of low-income, under- and uninsured patients. Adherence will be triangulated via VASdose, health record data, and refill records and compared to observed changes in HIV RNA. Health literacy will be evaluated via Rapid Estimate of Adult Literacy in Medicine - Short Form and Brief Estimate of Health Knowledge and Action - HIV Version. Clinical outcomes include HIV RNA (and standard lab values) at baseline, 2-8 weeks, 3 months, and 6 months. Statistical tests will assess the impact of SMS on adherence. Multivariable linear regression will explore associations between health literacy and HIV RNA levels. Significant findings will provide foundation for larger studies and may offer inexpensive yet powerful tools to increase adherence, improve patient outcomes, and reduce economic burden on public health.