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

• DOI: 10.1007/s10461-014-0971-0
• Publication Date: 2014-12-12T12:54:05Z
• Authors: 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; Colin A. Depp; Igor Grant; J. Hampton Atkinson
• Keywords: Male; Social Work; Bipolar Disorder; Bipolar disorder; Anti-HIV Agents; Reminder Systems; Clinical Trials and Supportive Activities; 610; HIV Infections; Comorbidity; Medication Adherence; 03 medical and health sciences; 0302 clinical medicine; Clinical Research; 616; Health Sciences; Behavioral and Social Science; Humans; Longitudinal Studies; Medication adherence; Intervention research; Assessment of Medication Adherence; Public health; Text Messaging; Behavior modification; Middle Aged; Serious Mental Illness; 16. Peace & justice; Mental Illness; Brain Disorders; 3. Good health; Good Health and Well Being; Mental Health; Infectious Diseases; mHealth; Randomized controlled trial; 6.1 Pharmaceuticals; Public Health and Health Services; HIV/AIDS; Sexually Transmitted Infections; Feasibility Studies; Female; Public Health; HIV Neurobehavioral Research Program (HNRP) Group; Follow-Up Studies

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.