Antiretroviral therapy self-management: Pilot study of an electronic medication event monitoring system among African-American women living with HIV in rural Florida (Preprint)

BACKGROUND The human immunodeficiency virus (HIV) remains a significant health issue in the United States and disproportionately affects African Americans. African-American women living with HIV (AAWH) experience a particularly high number of barriers when attempting to manage their HIV care, including antiretroviral therapy (ART) adherence. To enable the development and assessment of effective interventions that address these barriers to support ART adherence, there is a critical need to understand more fully the use of objective measures of ART adherence among AAWH, including electronic medication dispensers for real-time surveillance. OBJECTIVE To evaluate the use of the Wisepill Medication Event Monitoring System (MEMS), and compare objective and subjective measures of ART adherence. METHODS We conducted a 30-day exploratory sequential mixed-methods pilot study of the MEMS among a convenience sample of community-dwelling AAWH (n=14) in rural Florida. AAWH were trained on the use of the MEMS to determine the feasibility of collecting, capturing, and manipulating the MEMS data for an objective measure of ART adherence. Self-report sociodemographic information, including a measure of antiretroviral therapy (ART) adherence, was also collected from AAWH. RESULTS We found that a majority of participants were successful at using the electronic MEMS. Daily use of the MEMS tended to be outside of the usual time participants took their medication. Three 30-day medication event patterns were found that characterized ART adherence, specifically uniformed and ununiformed medication adherence and ununiformed medication non-adherence. There were relatively few MEMS disruption among study participants. Overall, adjusted daily ART adherence was 81.08% and subjective ART adherence was 77.78%. CONCLUSIONS This pilot study on the use and evaluation of the Wisepill MEMS among AAWH in rural Florida is the first known in the US. The findings of this study are encouraging because ten out of twelve participants consistently used the MEMS, had relatively few MEMS, and objective adjusted daily and overall subjective ART adherence were very similar. Based findings from this study, we think researchers can be confident in using the Wisepill MEMS in future studies of AAWH and PLWH in the US after considering our practical suggestions. The following practical considerations are suggested when considering measuring objective medication adherence: (1) before using a MEMS be familiar with the targeted populations’ characteristics; (2) choose a MEMS that aligns with the participants’ day-to-day activities; (3) ensure the MEMS’ features and resulting data support the research goals; (4) assess the match between user’s ability, wireless features of the MEMS, and the geographic location of participants; and (5) considering the cost of MEMS and the research budget.