Randomized Controlled Trial of a Personalized Cellular Phone Reminder System to Enhance Adherence to Antiretroviral Therapy
Randomized Controlled Trial of a Personalized Cellular Phone Reminder System to Enhance Adherence to Antiretroviral Therapy
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DOI：
10.1089/apc.2010.0006
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发表时间：
2011-03-01
影响因子：
4.9
通讯作者：
Skolnik, Paul R.
中科院分区：
文献类型：
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作者：
Hardy, Helene;Kumar, Vikram;Skolnik, Paul R.
坚持抗逆转录病毒治疗（ART）是艾滋病进展的最强预测因素之一，但大多数患者很难维持高水平的坚持。这项研究比较了个性化手机提醒系统 (ARemind) 与蜂鸣器在提高 ART 依从性方面的功效。 23 名接受 ART 的 HIV 感染者（自我报告的依从性低于 85%）被随机分配使用手机 (CP) 或寻呼机 (BP)。 CP 受试者每天都会收到个性化短信；相比之下，BP受试者在服药时会收到提示音。访谈安排在第 3 周和第 6 周。通过自我报告（SR，7 天回忆）、药物计数（PC，过去 30 天的基线，然后过去 3 周）、用药事件监测系统（MEMS；在第 3 周和第 6 周累积）以及通过结合 MEMS、药物计数和自我报告构建的综合依从性评分来衡量对 ART 的依从性。使用调整基线依从性的混合效应模型来比较干预组在第 3 周和第 6 周时的依从率。 19 名受试者完成了所有访视，其中 10 名男性和 9 名女性。平均年龄为 42.7 +/- 6.5 岁，37% 的受试者是白种人，89% 的受试者通过异性性行为感染艾滋病毒。基线时，SR 组和 PC 组的 ART 平均依从率为 79%，PC 组为 65%；在使用多种依从性指标后，ARemind 组的依从性在 6 周内有所增加并保持在显着较高水平。需要进行更大规模、更长期的前瞻性研究来证实这些发现，并更好地了解最佳提醒消息和用户疲劳。
Adherence to antiretroviral therapy (ART) represents one of the strongest predictors of progression to AIDS, yet it is difficult for most patients to sustain high levels of adherence. This study compares the efficacy of a personalized cell phone reminder system (ARemind) in enhancing adherence to ART versus a beeper. Twenty-three HIV-infected subjects on ART with self-reported adherence less than 85% were randomized to a cellular phone (CP) or beeper (BP). CP subjects received personalized text messages daily; in contrast, BP subjects received a reminder beep at the time of dosing. Interviews were scheduled at weeks 3 and 6. Adherence to ART was measured by self-report (SR, 7-day recall), pill count (PC, past 30 days at baseline, then past 3 weeks), Medication Event Monitoring System (MEMS; cumulatively at 3 and 6 weeks), and via a composite adherence score constructed by combining MEMS, pill count, and self report. A mixed effects model adjusting for baseline adherence was used to compare adherence rates between the intervention groups at 3 and 6 weeks. Nineteen subjects completed all visits, 10 men and 9 females. The mean age was 42.7 +/- 6.5 years, 37% of subjects were Caucasian and 89% acquired HIV heterosexually. The average adherence to ART was 79% by SR and 65% by PC at baseline in both arms; over 6 weeks adherence increased and remained significantly higher in the ARemind group using multiple measures of adherence. A larger and longer prospective study is needed to confirm these findings and to better understand optimal reminder messages and user fatigue.