Technology-Based Self-Care Methods of Improving Antiretroviral Adherence: A Systematic Review

Department of Medicine, University of CaliforniaSan Francisco, San Francisco, California, United States of America.
PLoS ONE (Impact Factor: 3.23). 11/2011; 6(11):e27533. DOI: 10.1371/journal.pone.0027533
Source: PubMed


As HIV infection has shifted to a chronic condition, self-care practices have emerged as an important topic for HIV-positive individuals in maintaining an optimal level of health. Self-care refers to activities that patients undertake to maintain and improve health, such as strategies to achieve and maintain high levels of antiretroviral adherence.
Technology-based methods are increasingly used to enhance antiretroviral adherence; therefore, we systematically reviewed the literature to examine technology-based self-care methods that HIV-positive individuals utilize to improve adherence. Seven electronic databases were searched from 1/1/1980 through 12/31/2010. We included quantitative and qualitative studies. Among quantitative studies, the primary outcomes included ARV adherence, viral load, and CD4+ cell count and secondary outcomes consisted of quality of life, adverse effects, and feasibility/acceptability data. For qualitative/descriptive studies, interview themes, reports of use, and perceptions of use were summarized. Thirty-six publications were included (24 quantitative and 12 qualitative/descriptive). Studies with exclusive utilization of medication reminder devices demonstrated less evidence of enhancing adherence in comparison to multi-component methods.
This systematic review offers support for self-care technology-based approaches that may result in improved antiretroviral adherence. There was a clear pattern of results that favored individually-tailored, multi-function technologies, which allowed for periodic communication with health care providers rather than sole reliance on electronic reminder devices.

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    • "This forms the basis of a 10–15 minute discussion, identifying patterns and planning for ways to improve. Incorporation of an in-person meeting is consistent with participants’ preference for technology-based interventions that are combined with interpersonal support [41], and with a meta-analysis indicating that interventions involving some personal contact are more effective than interventions that are entirely electronically delivered [42]. "
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    • "Subsequently, a variety of electronic devices, such as pagers [31], disease management assistance system (DMAS) [32], electronic pill-cap [33], and alarms, have been used to regularly remind patients to take their medication [34]. A recent systematic review [35] confirmed that these devices may result in improved adherence to ART. However, these devices have drawbacks, including inconvenience, high cost, and patient dissatisfaction due to privacy concerns [36, 37]. "
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