Pillbox Organizers are Associated with Improved Adherence to HIV Antiretroviral Therapy and Viral Suppression: a Marginal Structural Model Analysis
Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)–infected subjects who were observed from 1996 through 2000 i...
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| Published in | Clinical infectious diseases Vol. 45; no. 7; pp. 908 - 915 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
The University of Chicago Press
01.10.2007
University of Chicago Press Oxford University Press |
| Subjects | |
| Online Access | Get full text |
| ISSN | 1058-4838 1537-6591 1537-6591 |
| DOI | 10.1086/521250 |
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| Abstract | Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)–infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Results. Pillbox organizer use was estimated to improve adherence by 4.1%–4.5% and was associated with a decrease in viral load of 0.34–0.37 log10 copies/mL and a 14.2%–15.7% higher probability of achieving a viral load ⩽400 copies/mL (odds ratio, 1.8–1.9). All effect estimates were statistically significant. Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of ∼$19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. |
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| AbstractList | Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)–infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Results. Pillbox organizer use was estimated to improve adherence by 4.1%–4.5% and was associated with a decrease in viral load of 0.34–0.37 log10 copies/mL and a 14.2%–15.7% higher probability of achieving a viral load ⩽400 copies/mL (odds ratio, 1.8–1.9). All effect estimates were statistically significant. Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of ∼$19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)-infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Pillbox organizer use was estimated to improve adherence by 4.1%-4.5% and was associated with a decrease in viral load of 0.34-0.37 log10 copies/mL and a 14.2%-15.7% higher probability of achieving a viral load < or = 400 copies/mL (odds ratio, 1.8-1.9). All effect estimates were statistically significant. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of approximately $19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)-infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4⁺ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Results. Pillbox organizer use was estimated to improve adherence by 4.1%-4.5% and was associated with a decrease in viral load of 0.34-0.37 log₁₀ copies/mL and a 14.2%-15.7% higher probability of achieving a viral load ≤400 copies/mL (odds ratio, 1.8-1.9). All effect estimates were statistically significant. Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of ∼$19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human Immunodeficiency virus (HIV)-infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4 super(+) T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Results. Pillbox organizer use was estimated to Improve adherence by 4.1%-4.5% and was associated with a decrease in viral load of 0.34-0.37 log sub(10) copies/mL and a 14.2%-15.7% higher probability of achieving a viral load less than or equal to 400 copies/mL (odds ratio, 1.8-1.9). All effect estimates were statistically significant. Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of similar to $19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown.BACKGROUNDPillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown.Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)-infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment.METHODSData were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)-infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment.Pillbox organizer use was estimated to improve adherence by 4.1%-4.5% and was associated with a decrease in viral load of 0.34-0.37 log10 copies/mL and a 14.2%-15.7% higher probability of achieving a viral load < or = 400 copies/mL (odds ratio, 1.8-1.9). All effect estimates were statistically significant.RESULTSPillbox organizer use was estimated to improve adherence by 4.1%-4.5% and was associated with a decrease in viral load of 0.34-0.37 log10 copies/mL and a 14.2%-15.7% higher probability of achieving a viral load < or = 400 copies/mL (odds ratio, 1.8-1.9). All effect estimates were statistically significant.Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of approximately $19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy.CONCLUSIONPillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of approximately $19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)–infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4+ T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Results. Pillbox organizer use was estimated to improve adherence by 4.1%–4.5% and was associated with a decrease in viral load of 0.34–0.37 log10 copies/mL and a 14.2%–15.7% higher probability of achieving a viral load ⩽400 copies/mL (odds ratio, 1.8–1.9). All effect estimates were statistically significant. Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of ∼$19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Data were obtained from an observational cohort of 245 human immunodeficiency virus (HIV)-infected subjects who were observed from 1996 through 2000 in San Francisco, California. Adherence was the primary outcome and was measured using unannounced monthly pill counts. Plasma HIV RNA level was considered as a secondary outcome. Marginal structural models were used to estimate the effect of pillbox organizer use on adherence and viral suppression, adjusting for confounding by CD4... T cell count, viral load, prior adherence, recreational drug use, demographic characteristics, and current and past treatment. Pillbox organizer use was estimated to improve adherence by 4.1 %- 4.5% and was associated with a decrease in viral load of 0.34-0.37 log... copies/mL and a 14.2%-15.7% higher probability of achieving a viral load ≤400 copies/mL (odds ratio, 1.8-1.9). All effect estimates were statistically significant. Conclusion. Pillbox organizers appear to significantly improve adherence to antiretroviral therapy and to improve virologic suppression. We estimate that pillbox organizers may be associated with a cost of ...$19,000 per quality-adjusted life-year. Pillbox organizers should be a standard intervention to improve adherence to antiretroviral therapy. (ProQuest: ... denotes formulae/symbols omitted.) |
| Author | Petersen, Maya L. Guzman, David van der Laan, Mark J. Wang, Yue Bangsberg, David R. Riley, Elise |
| AuthorAffiliation | 2 Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, University of California at San Franscisco AIDS Research Institute, San Francisco General Hospital, University of California at San Francisco 1 Division of Biostatistics, University of California at Berkeley School of Public Health, University of California at Berkeley 3 The Positive Health Program, University of California at San Franscisco AIDS Research Institute, San Francisco General Hospital, University of California at San Francisco |
| AuthorAffiliation_xml | – name: 3 The Positive Health Program, University of California at San Franscisco AIDS Research Institute, San Francisco General Hospital, University of California at San Francisco – name: 2 Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, University of California at San Franscisco AIDS Research Institute, San Francisco General Hospital, University of California at San Francisco – name: 1 Division of Biostatistics, University of California at Berkeley School of Public Health, University of California at Berkeley |
| Author_xml | – sequence: 1 givenname: Maya L. surname: Petersen fullname: Petersen, Maya L. organization: Division of Biostatistics, University of California at Berkeley School of Public Health, University of California at Berkeley, University of California at San Francisco – sequence: 2 givenname: Yue surname: Wang fullname: Wang, Yue organization: Division of Biostatistics, University of California at Berkeley School of Public Health, University of California at Berkeley, University of California at San Francisco – sequence: 3 givenname: Mark J. surname: van der Laan fullname: van der Laan, Mark J. organization: Division of Biostatistics, University of California at Berkeley School of Public Health, University of California at Berkeley, University of California at San Francisco – sequence: 4 givenname: David surname: Guzman fullname: Guzman, David organization: Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, University of California at San Francisco – sequence: 5 givenname: Elise surname: Riley fullname: Riley, Elise organization: Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, University of California at San Francisco – sequence: 6 givenname: David R. surname: Bangsberg fullname: Bangsberg, David R. email: 94143-1372db@epi-center.ucsf.edu organization: Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, University of California at San Francisco |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/17806060$$D View this record in MEDLINE/PubMed |
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| References | (16_40164470) 2004; 3 Rigsby (28_10582923) 2000; 15 (7_38262644) 2002; 30 Hogg (6_17005528) 2002; 16 Zolopa (11_15558002) 1994; 272 Goldie (29_17939404) 2003; 115 (4_38258550) 2001; 33 Huang (20_10527075) 2000; 152 Bangsberg (5_11201501) 2001; 15 Remien (24_18899915) 2005; 19 Wagner (30_16893073) 2002; 3 Winland-Brown (22_10680153) 2000; 4 Hern n (10_17141991) 2002; 21 Robertson (12_18242801) 2004; 94 Paterson (3_10362639) 2000; 133 (18_22950000) 2006; 296 Weber (27_18103362) 2004; 9 (8_25910689) 2001; 5 Connor (19_18649173) 2004; 82 (17_33793100) 2005; 129 (25_38222902) 2005; 41 Bangsberg (2_6555876) 2000; 14 Golin (23_17292825) 2002; 17 Wagner (21_17505907) 2003; 14 Rathbun (26_18781227) 2005; 27 Osterberg (1_19308503) 2005; 353 Robins (9_10443658) 2000; 11 17806061 - Clin Infect Dis. 2007 Oct 1;45(7):916-7. doi: 10.1086/521249. |
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| Snippet | Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were... Background. Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Methods. Data were... Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Data were obtained from an... Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown. Data were obtained from an... Pillbox organizers are inexpensive and easily used; however, their effect on adherence to antiretroviral medications is unknown.BACKGROUNDPillbox organizers... |
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| SubjectTerms | Adult AIDS Analysis Anti-Retroviral Agents - administration & dosage Antiretroviral drugs Antiretrovirals Antivirals Cohort Studies Dosage forms Drug therapy Estimators Female HIV HIV Infections - drug therapy HIV/AIDS Human immunodeficiency virus Humans Ill-Housed Persons Male Medication Systems Medications Middle Aged Patient Compliance Pills Retrospective Studies San Francisco Self Administration - methods T lymphocytes Urban Population Viral Load |
| Title | Pillbox Organizers are Associated with Improved Adherence to HIV Antiretroviral Therapy and Viral Suppression: a Marginal Structural Model Analysis |
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