In a study from Johns Hopkins, a pocket-sized device
giving electronic-voice reminders to "take your medicine"
proves to be a success for people living with HIV whose
memory is slightly impaired by the virus.
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 and 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, 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,"
Adriana Andrade, assistant professor at the School of
Medicine's Division
of Infectious Diseases, said. "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, or HAART. Those who miss their medication a few
times quickly develop a viral resistance to the drug, a
problem as replacement options are few.
"On average, HIV-infected, treatment-naive 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," Andrade said. "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," Andrade said. "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 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 only a 57 percent adherence rate. 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," Andrade said.
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, Albert Wu, Shivaun Celano, Richard Skolasky Jr.,
Ola Selnes, I-Chan Huang and Justin McArthur.
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