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Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions

  • Behavioral-Bio-Medical Interface (RJ DiClemente and JL Brown, Section Editors)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Traditional methods to assess antiretroviral adherence, such as self-report, pill counts, and pharmacy refill data, may be inaccurate in determining actual pill-taking to both antiretroviral therapy (ART) or pre-exposure prophylaxis (PrEP). HIV viral loads serve as surrogates of adherence on ART, but loss of virologic control may occur well after decreases in adherence and viral loads are not relevant to PrEP.

Recent Findings

Pharmacologic measures of adherence, electronic adherence monitors, and ingestible electronic pills all serve as more objective metrics of adherence, surpassing self-report in predicting outcomes. Pharmacologic metrics can identify either recent adherence or cumulative adherence. Recent dosing measures include antiretroviral levels in plasma or urine, as well as emtricitabine-triphosphate in dried blood spots (DBS) for those on tenofovir-emtricitabine-based therapy. A urine tenofovir test has recently been developed into a point-of-care test for bedside adherence monitoring. Cumulative adherence metrics assess adherence over weeks to months and include measurement of tenofovir-diphosphate in peripheral blood mononuclear cells or DBS, as well as ART levels in hair. Electronic adherence monitors and ingestible electronic pills can track pill bottle openings or medication ingestion, respectively.

Summary

New and objective approaches in adherence monitoring can be used to detect nonadherence prior to loss of prevention efficacy or virologic control with PrEP or ART, respectively.

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Acknowledgments

M.A.S. was supported by NIAID/NIH T32AI060530 (P.I. Havlir) and NIMH/NIH K23MH122286. J.E.H. is supported by NIMH K24MH114732. P.R.C. is supported by NIDA/NIH K23DA044874. J.C.M. is supported by NIAID R01AI145453. P.L.A is supported by NIAID R01AI122298.. M.G. is supported by NIAID R01AI143340, 2R01AI098472, and R03AI152773.

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Authors and Affiliations

  1. Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA

    Matthew A. Spinelli & Monica Gandhi

  2. Center for Global Health, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Jessica E. Haberer

  3. Department of Emergency Medicine, Brigham and Women’s Hospital/Harvard, Boston, MA, USA

    Peter R. Chai

  4. Division of Infectious Diseases, University of Colorado-Denver, Denver, CO, USA

    Jose Castillo-Mancilla

  5. Department of Pharmaceutical Sciences, University of Colorado-Denver, Denver, CO, USA

    Peter L. Anderson

  6. San Francisco, CA, USA

    Monica Gandhi

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Correspondence to Monica Gandhi.

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M.A.S., P.R.C., J.C.M., and M.G. have no relevant conflicts of interest to report. P.L.A. has received grant funding from Gilead. J.E.H. has accepted consulting funds from Merck Pharmaceuticals.

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Spinelli, M.A., Haberer, J.E., Chai, P.R. et al. Approaches to Objectively Measure Antiretroviral Medication Adherence and Drive Adherence Interventions. Curr HIV/AIDS Rep 17, 301–314 (2020). https://doi.org/10.1007/s11904-020-00502-5

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  • DOI: https://doi.org/10.1007/s11904-020-00502-5

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