Pill box organizers increase HIV patients' adherence and improve viral suppression

“Clinicians and pharmacists can meaningfully improve treatment outcomes with simple and inexpensive strategies, such as pill box organizers, to help people organize how they take medication,” said senior author David Bangsberg, MD, MPH, of UCSF.

Incomplete adherence to HIV therapy is the most common cause of incomplete viral suppression, drug resistance, disease progression, and death among people living with HIV/AIDS. The subjects of this study, who were recruited from homeless shelters, free food programs, and single-room occupancy hotels, are thought to be at elevated risk for poor adherence partly because of the high rates of substance abuse, untreated mental illness, and unstable housing.

Patients in this difficult-to-treat population were given inexpensive pill box organizers to use with their antiretroviral medications. Study organizers made a total of 3,170 unannounced visits every three to six weeks to the subjects’ places of residence and compared the number of pills remaining in the patients’ possession with the number that would be expected to remain if the patients were perfectly compliant with the treatment regimen.

Pill box organizers were associated with a 4 percent improvement in adherence, 0.12 log reduction in HIV viral load, and an estimated 11 percent reduction in the risk of progression to clinical AIDS. At only $5 per pill box, this intervention was highly cost-effective.

“While this population has often been regarded as having difficulty with adherence,” the authors write, “adherence problems are by no means limited to patients with low socioeconomic status.” Lead author Maya Petersen, PhD, from the Berkeley School of Public Health, adds, “Incomplete adherence is a major problem that prevents people from realizing the full benefits of a wide range of treatments for chronic diseases, such as hypertension and diabetes mellitus. Thus, the findings of this study have the potential to inform a wide range of diseases, not just HIV.

“It would be interesting to explore whether changes in packaging or delivery of antiretrovirals and other drugs could be used to reproduce the benefits of pill box organizer use. One model to consider is oral contraceptive therapy, which is routinely dispensed using labeled blister packs, a kind of pre-packaged version of a pill box. Antiretroviral regimens are generally more complicated, but a modification of this general model at either a pharmacy or manufacturer level might be possible, with wide-ranging patient benefits.”