Pillbox Can Help ARV Adherence

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Pillbox Organizers Can Help Maintain Antiretroviral Regimen

Adherence, Slow Progression of HIV to AIDS, Study Says

HIV-positive people who use pillbox organizers to help adhere to

their antiretroviral drug regimens could reduce the risk of

progressing to AIDS, according to a study published in the October

issue of the journal Clinical Infectious Diseases, Reuters Health

reports.

For the study, Bangsberg of San Francisco General Hospital and

colleagues followed 245 HIV-positive people from 1996 to 2000. The

researchers periodically tracked the participants' adherence to their

antiretroviral regimens by conducting unannounced pill counts every

three to six weeks. All study participants were taking a minimum of

three different medications.

The researchers used three statistical models to compare adherence

for individuals who chose to use pillbox organizers and those who did

not. Sixty-one percent of the study participants used the organizers

for at least one month during the course of the study. The

researchers found that pillbox users increased their adherence to

prescribed drug regimens by up to 4.5%. They also had substantially

lower levels of HIV in their blood and were nearly twice as likely to

have a viral load of 400 virus copies per milliliter or less. Pillbox

users also were 11% less likely than nonusers to progress to AIDS

during the course of the study.

Conclusions

" Pillbox organizers should be a standard intervention to improve

adherence to antiretroviral therapy, " the researchers wrote, adding

that people living with HIV who do not fully adhere to prescribed

regimens increase their risk of developing drug resistance,

progressing to AIDS and death. The researchers acknowledged that

antiretroviral regimens are simpler now than when the study was

conducted, so it is unclear whether pillbox organizers would be as

helpful for patients today. However, they added that " given the

simplicity and low cost of the intervention, clinicians should

consider including pillbox organizers in their routine treatment of

chronic disease " (Reuters Health, 9/12).

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Abstract:

Pillbox Organizers Are Associated with Improved Adherence to HIV

Antiretroviral Therapy and Viral Suppression: A Marginal Structural

Model Analysis

Maya L. sen, Yue Wang, Mark J. van der Laan, Guzman, Elise

Riley, and R. Bangsberg

Journal Clinical Infectious Diseases

Volume 45(2007), pages 908 - 915

DOI: 10.1086/521250

Abstract

Background. Pillbox organizers are inexpensive and easily used;

however, their effect on adherence to antiretroviral medications is

unknown.

Methods. Data were obtained from an observational cohort of 245 human

immunodeficiency virus (HIV) infected subjects who were observed from

1996 through 2000 in San Francisco, California. Adherence was the

primary outcome and was measured using unannounced monthly pill

counts. Plasma HIV RNA level was considered as a secondary outcome.

Marginal structural models were used to estimate the effect of

pillbox organizer use on adherence and viral suppression, adjusting

for confounding by CD4+ T cell count, viral load, prior adherence,

recreational drug use, demographic characteristics, and current and

past treatment.

Results. Pillbox organizer use was estimated to improve adherence by

4.1% 4.5% and was associated with a decrease in viral load of 0.34

0.37 log10 copies/mL and a 14.2% 15.7% higher probability of

achieving a viral load 400 copies/mL (odds ratio, 1.8 1.9). All

effect estimates were statistically significant.

Conclusion. Pillbox organizers appear to significantly improve

adherence to antiretroviral therapy and to improve virologic

suppression. We estimate that pillbox organizers may be associated

with a cost of $19,000 per quality-adjusted life-year. Pillbox

organizers should be a standard intervention to improve adherence to

antiretroviral therapy.