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Individualized Texting for Adherence Building (iTAB): Improving Antiretroviral Dose Timing Among HIV-Infected Persons with Co-occurring Bipolar Disorder

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Abstract

HIV+ persons with co-occurring bipolar disorder (HIV+/BD+) have elevated rates of medication nonadherence. We conducted a 30-day randomized controlled trial of a two-way, text messaging system, iTAB (n = 25), compared to an active comparison (CTRL) (n = 25) to improve antiretroviral (ARV) and psychotropic (PSY) adherence and dose timing. Both groups received medication adherence psychoeducation and daily texts assessing mood. The iTAB group additionally received personalized medication reminder texts. Participants responded to over 90 % of the mood and adherence text messages. Mean adherence, as assessed via electronic monitoring caps, was high and comparable between groups for both ARV (iTAB 86.2 % vs. CTRL 84.8 %; p = 0.95, Cliff’s d = 0.01) and PSY (iTAB 78.9 % vs. CTRL 77.3 %; p = 0.43, Cliff’s d = −0.13) medications. However, iTAB participants took ARVs significantly closer to their intended dosing time than CTRL participants (iTAB: 27.8 vs. CTRL: 77.0 min from target time; p = 0.02, Cliff’s d = 0.37). There was no group difference on PSY dose timing. Text messaging interventions may represent a low-burden approach to improving timeliness of medication-taking behaviors among difficult-to-treat populations. The benefits of improved dose timing for long-term medication adherence require additional investigation.

Resumen

Las personas infectadas con VIH y que a la vez tienen trastorno bipolar (VIH+/BD+), tienen tasas elevadas de no adherencia a medicamentos. En el presente estudio, hemos llevado a cabo un ensayo controlado aleatorio comparando un sistema de mensajes de texto, ITAB (n = 25), con un grupo control (CTRL) (n = 25). El objectivo del estudio fue mejorar la adherencia a medicamentos antirretrovirales (ARV) y psicotrópicos (PSY) y también mejorar la sincronización de las dosis. Ambos grupos recibieron psicoeducación sobre la importancia de la adherencia a los medicamentos y textos diarios evalúando el estado de ánimo. El grupo ITAB recibió adicionalmente mensajes de textos personalizados que les recordaban tomar los medicamentos. Todos los participantes respondieron a más del 90 % de los mensajes de texto sobre el estado de ánimo y la adherencia. El promedio de adherencia, evaluado a través de las tapaderas de monitoreo electrónico fue alto y comparable entre los grupos para los dos medicamentos, ARV (ITAB 86,2 % frente a 84,8 % CTRL; p = 0,95, Cliff’s d = 0,01) y PSY (ITAB 78,9 % frente a 77,3 % CTRL; p = 0,43, Cliff’s d = −0,13). Sin embargo, los participantes en el grupo ITAB tomaron medicamentos ARV significativamente más cerca del tiempo en que debían tomarlos que los participantes CTRL (ITAB : 27,8 vs. CTRL : 77,0 minutos desde el momento en que debían tomarlos; p = 0,02, Cliff’s d = 0,37). No hubo diferencia entre los grupos en la sincronización de la dosis para los medicamentos PSY. En conclusión, intervenciones utilizando mensajes de texto pueden representar una forma mas fácil de mejorar la puntualidad en la que individuos difíciles de tratar deben tomarse los medicamentos. Sin embargo, los beneficios de mejorar la sincronización en la dosis de medicamentos y la adherencia a estos a largo plazo requieren investigación adicional.

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Acknowledgments

The present work was supported by California HIV/AIDS Research Program IDEA Award ID09-SD-047 (D.J. Moore, PI) as well as the HIV Neurobehavioral Research Center (HNRC) NIMH/CSPAR Award Number P30MH062512 (R.K. Heaton, PI).

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Authors and Affiliations

  1. Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA

    David J. Moore, Amelia Poquette, Ben Gouaux, Alexandra S. Rooney, Jayraan Badiee, Reena Deutsch, Colin A. Depp, Igor Grant & J. Hampton Atkinson

  2. SDSU/UCSD Joint Doctoral Program in Clinical Psychology, San Diego, CA, 92120, USA

    Kaitlin B. Casaletto, Jessica L. Montoya & Carolina Posada

  3. Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, 92093, USA

    Scott L. Letendre

  4. Psychiatry Service, VA San Diego Healthcare System, San Diego, CA, 92161, USA

    J. Hampton Atkinson

  5. HIV Neurobehavioral Research Program, 220 Dickinson St., Suite B, Mail Code 8231, San Diego, CA, 92103-8231, USA

    David J. Moore, Amelia Poquette, Kaitlin B. Casaletto, Ben Gouaux, Jessica L. Montoya, Carolina Posada, Alexandra S. Rooney, Jayraan Badiee, Reena Deutsch, Scott L. Letendre, Igor Grant & J. Hampton Atkinson

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  1. David J. Moore
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The HIV Neurobehavioral Research Program (HNRP) Group

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Correspondence to David J. Moore.

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The members of the HIV Neurobehavioral Research Program (HNRP) Group given in the "Appendix".

Appendix: HIV Neurobehavioral Research Program (HNRP) Group

Appendix: HIV Neurobehavioral Research Program (HNRP) Group

The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and includes: Director: Robert K. Heaton, Ph.D., Co-Director Igor Grant, M.D.; Associate Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and Scott Letendre, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Jennifer Marquie-Beck, M.P.H.; Melanie Sherman; Neuromedical Component Ronald J. Ellis, M.D., Ph.D. (P.I.), Scott Letendre, M.D., J. Allen McCutchan, M.D., Brookie Best, Pharm.D., Rachel Schrier, Ph.D., Debra Rosario, M.P.H.; Neurobehavioral Component Robert K. Heaton, Ph.D. (P.I.), J. Hampton Atkinson, M.D., Steven Paul Woods, Psy.D., Thomas D. Marcotte, Ph.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component Christine Fennema-Notestine, Ph.D. (P.I.), Monte S. Buchsbaum, M.D., John Hesselink, M.D., Sarah L. Archibald, M.A., Gregory Brown, Ph.D., Richard Buxton, Ph.D., Anders Dale, Ph.D., Thomas Liu, Ph.D.; Neurobiology Component Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D.; Neurovirology Component: David M. Smith, M.D. (P.I.), Douglas Richman, M.D.; International Component J. Allen McCutchan, M.D., (P.I.), Mariana Cherner, Ph.D.; Developmental Component Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit J. Hampton Atkinson, M.D. (P.I.), Jennifer Marquie-Beck, M.P.H.; Data Management and Information Systems Unit Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman; Statistics Unit Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D. (Co-PI), Reena Deutsch, Ph.D., Anya Umlauf, M.S.

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Moore, D.J., Poquette, A., Casaletto, K.B. et al. Individualized Texting for Adherence Building (iTAB): Improving Antiretroviral Dose Timing Among HIV-Infected Persons with Co-occurring Bipolar Disorder. AIDS Behav 19, 459–471 (2015). https://doi.org/10.1007/s10461-014-0971-0

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