The investigators report that the device, dubbed "Jerry" by most users, is a portable gadget programmed to ease the task of taking medicines in multiple doses every day on time. HIV-infected patients, particularly those suffering from mild memory loss from the disease, benefit highly from Jerry's friendly reminders, according to a study published in the Sept. 15 issue of the journal Clinical Infectious Diseases.
Like an alarm clock, Jerry, more properly known as Disease Management Assistance System (DMAS), flashes a light and verbally tells the patient the exact dosage and medication to take at the correct time. DMAS is rechargeable and weighs about as much as a cell phone. Its computer programming keeps track of the patient's compliance, allowing the doctor to download and print a report for monitoring the patient's adherence to the medication schedule.
"One of the biggest reasons HIV patients cite for not taking their medication is just plain forgetfulness," says Adriana Andrade, M.D., M.P.H., assistant professor at the Johns Hopkins University Division of Infectious Diseases. "We thought a verbal reminder would be the best possible solution."
According to Andrade, treating HIV can be a grueling task for patients who must follow a hectic pill schedule, a combination of drugs called highly active antiretroviral therapy (HAART). Those who miss their medication a few times quickly develop a viral resistance to the drug, a problem since replacement options are few.
"On average, HIV-infected, treatment-naïve patients today take roughly two pills once a day, a significant decrease from a few years ago, when patients had to juggle dozens of medications per week," says Andrade. "But with all the regimens, patients must adhere to their medication faithfully because the virus easily develops a resistance, more so than most infectious diseases."
HIV can cause brain damage, making it more difficult for some patients to remember their HAART regimen, which is often different for every patient.
"We recruited patients with either normal memory or mild memory impairment for the study," says Andrade. "The results indicate that both groups adhered to their medication more so than not with Jerry, but the memory-impaired patients showed a greater improvement."
Fifty-eight of 64 patients completed the four-month study. Half of the patients were given a Jerry device and attended adherence counseling sessions, while the other half received only counseling. Those with Jerry took their medication 80 percent of the time, while those without did so only 65 percent of the time.
Of the 31 memory-impaired patients, those using Jerry had a 77 percent adherence rate, while those without Jerry had a 57 percent adherence rate, a 20 percent difference. The remaining patients with normal memory also adhered more with Jerry, but there was not a significant variance from those without the device, according to the researchers.
Throughout the study, all patients were given plasma viral load tests, which measure the amount of HIV in the blood. However, there was no significant difference in lessening the HIV amount between those with or without Jerry, according to the researchers.
"Hopefully, other devices like the DMAS will be further evaluated in similar studies, while incorporating the recent technologies of the two-way pager, cell phones or special alarm clocks," says Andrade.
The DMAS used in this study was manufactured by Adherence Technologies.
Funding was provided by grants from the National Institutes of Health, the Johns Hopkins Hospital General Clinical Research Center and Merck Laboratories.
Other researchers involved in the study were Henraya McGruder, Ph.D.; Albert Wu, M.D., M.P.H.; Shivaun Celano, Pharm.D.; Richard Skolasky Jr., M.A.; Ola Selnes, Ph.D.; I-Chan Huang, Ph.D.; and Justin McArthur, M.B.B.S., M.P.H.