When it comes to chronic diseases like HIV, treatment adherence is paramount. As former US Surgeon General C. Everett Koop once said, "Drugs don't work in patients who don't take them." But a study published earlier this week in PLoS Medicine found that it's not always as simple as giving patients an electronic reminder. While counseling improved treatment adherence in newly-diagnosed HIV patients, pocket alarms meant to remind patients to take their medication did not. The results have significant policy implications, particularly in the developing world, where funding for adherence strategies is scarce.
The authors of the PLoS paper point out that HIV treatment adherence in Africa, where they completed their study, is already pretty high (about 80 percent), and that additional spending on adherence programs there may be unwarranted, not to mention a waste of valuable resources.
The pocket alarm used in the study, the ALRT PC200, may be effective in other settings, but experts say forgetfulness is rarely the reason for adherence problems in HIV patients. Instead, they say, HIV patients are more likely to stop their taking their medication because of complex factors, such as depression and stigma, that are better addressed by counseling.
This is not the first study to show that reminder alarms don't always have their intended effect. But that doesn't mean there's no role for these kinds of technologies in treatment adherence programs. In fact, there is evidence that reminder technologies that incorporate positive feedback, such as supportive text messages, can be quite effective at addressing improving HIV treatment adherence. The key, as always, is figuring out which technological approaches work best and why so that money and time aren't wasted on ineffective strategies.