Real-Time Electronic Drug Monitoring for HIV-Positive Adolescents: Promising Acceptability and Feasibility in China

Abstract

Objective: Little research to date has focused on measuring adherence among and tailoring adherence interventions to HIV-positive youth. To explore the potential of emerging mHealth technologies as adherence tools for youth, we assessed the acceptability and feasibility of a real-time web-linked electronic drug monitoring (EDM) device to support antiretroviral (ART) adherence among HIV-positive adolescents in China. Methods: Twenty patients ages 10-15 years who were on ART at the Guangxi Center for Disease Control ART clinic in Nanning, China used a wireless EDM device for medication for one month. We monitored adherence in real time, and explored the device’s acceptability among patients using a mixed-methods approach. Results: Using EDM data, median adherence was 93.9% (IQR 10.2) of prescribed doses taken and 90.2% (IQR 13.3) using the on-time measure. Only 20% (4/20) of patients met the strictest generally-accepted criterion for optimal adherence (≥ 95% using on-time measure) over the observation period. Self-reported median adherence for the month was 100% proportion taken. Although they expressed concerns about inconvenience and the device’s size and appearance in open-ended questions, all adolescent participants reported a positive overall experience with the device in closed-ended questions. Conclusion: Wireless EDM technology represents an acceptable and rigorous method of measuring ART adherence, and a potentially useful adherence support, for HIV-positive adolescents at a critical time in their lives, as well as for adolescents who take medications for other chronic health conditions. Future studies should focus on identifying ways of strengthening caregiver-adolescent relationships and developing tailored, age-appropriate intervention packages to support adherence.