(ACTG) A5288 (MULTI-OCTAVE) is one of the first studies to look at interventions for medication adherence in lower-income and middle-income countries (LMICs) for individuals failing second line therapy. All participants in this unprecedented prospective interventional study were failing 2nd line ART, with the majority on lopinavir/ritonavir-based ART. Participants were either kept on that regimen or randomized to receiving third line ART regimens based on the results of viral genotyping on enrollment, and followed for a median of 72 weeks.
A randomized cell phone-based adherence support intervention was conducted among most of the study participants. In the intervention, field staff would text participants to see how they were doing in terms of taking the ART and participants would text back, first daily and then tapering down to once a week. The study showed a small (but not significant) benefit of a mobile phone-based intervention for ART adherence on the primary outcome of achieving virological suppression at 48 weeks, and a small (and statistically significant) effect on the outcome of time to virological failure.
The authors conclude that adherence behavior is challenging and that two-way text messaging might help a bit, but does not seem to be as fruitful as hoped. Therefore, more research on this and other adherence support strategies are needed.
Gross R, Ritz J, Hughes MD, Salata R, Mugyenyi P, Hogg E, Wieclaw L, Godrey C, Wallis CL, Mellors JW, Mudhune VO, Badal-Faesen S, Grinsztejn B, Collier AC. Two-way mobile phone intervention compared with standard-of-care adherence support after second-line antiretroviral therapy failure: a multinational, randomized controlled trial. Lancet Digital Health 2019; 1: e26–34