This article is more than 5 years old. Information may no longer be current.
Pillbox use may improve medication adherence in patients with HIV
Click Here to Manage Email Alerts
Patients with HIV who are of a lower socioeconomic status and live in urban areas who used pill box organizers showed improved compliance, improved virologic suppression and decreased risk for HIV progression in a recent study.
Researchers estimated the pillbox organizers could be associated with an estimated $19,000 per quality-adjusted life-years in patients who use the simple strategy to track HIV medications.
“Incomplete adherence is an obstacle to therapy, but a pillbox that costs less than $5 and offers no risk can have an important impact on improving adherence,” David R. Bangsberg, MD, MPH, associate professor of medicine at University of California, San Francisco, and one of the study’s researchers, told Infectious Disease News.
Bangsberg said physicians should give pillbox organizers to patients who take medications for any chronic disease because the simple, inexpensive strategy could improve patients’ lives.
“If we can improve adherence in homeless and marginally-housed people with HIV, it’s not a big stretch to think that pillboxes would help in other populations taking medical therapy for chronic diseases,” Bangsberg said.
The study appeared in Clinical Infectious Diseases.
Patients given pillboxes
Data were collected from patients with HIV (n=245) from an observational cohort conducted from 1996 through 2000 in San Francisco.
All participants were taking three or more antiretroviral medications for at least one month. Patients were 58% nonwhite; 32% were current injection drug users. Participants were recruited from single-room occupancy hotels, homeless shelters and free-meal programs and were identified through the REACH cohort, a systematic sample of low income and marginally-housed adults with HIV in San Francisco.
At the study start, 62% of participants were receiving protease inhibitor-based therapy.
Adherence, the primary outcome, was measured by unannounced monthly pill counts at each patient’s residence. Pill counts were conducted on all medications every three to six weeks during a 12-month period. Blood samples were collected monthly. Seventy-two percent of patients (n=269) received 3,170 total unannounced adherence monitoring visits during the study.
Marginal structure models were used to estimate the effect of pillbox organizers on adherence and viral suppression, adjusting for changes in CD4 count, viral load, prior adherence, recreational drug use, demographic characteristics and present and past treatments. Plasma HIV RNA level changes were the secondary endpoint.
Adherence increased
Pillbox organizer use improved adherence by an estimated 4.1%-4.5%. Use was also associated with decreased viral loads of 0.34 logs10 copies/mL to 0.37 logs10.
Patients who used the pillbox organizers had a 14.2% to 15.7% higher probability of achieving a viral load of 400 or less copies/mL. Pillbox use was also associated with an 11% reduction in the risk of HIV progression.
Adherence measurements were available for 95% of the 2,504 person-months analyzed in the study. Mean adherence to pillbox organizer use was 73%.
Of 139 pillbox users, 72% achieved mean viral loads of fewer than 400 copies/mL during at least one follow-up. – by Kirsten H. Ellis
For more information:
- Petersen ML, Wang Y, van der Laan MJ, et al. Pillbox organizers are associated with improved adherence to HIV antiretroviral therapy and viral suppression: a marginal structural model analysis. Clin Infect Dis. 2007;45:908-915.