A Two-way Messaging System to Enhance Antiretroviral Adherence

A better understanding of HIV pathogenesis and viral dynamics, the availability of highly active antiretroviral therapy (HAART), and viral load and resistance assays have given clinicians and patients the ability to manage HIV infection and have resulted in dramatic decreases in the numbers of AIDSrelated deaths and opportunistic infections. The effectiveness of HAART, however, depends on strict adherence to often complex medication regimens. In fact, adherence levels of 95% may be needed to achieve the best virologic outcomes. The expanding field of medical technology, however, holds great potential for behavioral health promotion interventions. Studies using communicating devices, such as pagers, alarms, and telephones, though generally small and uncontrolled, show promising results. 9 Alarm devices have been shown to increase adherence. For example, Frick et al. found that 82% of women on a once-daily regimen who were randomized to use an alarm device were 95% adherent compared with 36% of the women without an alarm. 10 Erickson et al. used pagers with tailored messages to remind patients to take their asthma medications and found that patients felt comfortable using the pager, easily learned the features, readily integrated the use of the pager into their daily routines, generally perceived the messages as very useful, and showed improvement in self-reported adherence to both oral and inhaled medications. In anoth-11