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1 October 2007

Volume 45, Number 7
Clinical Infectious Diseases 2007;45:908–915
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4507-0016$15.00
DOI: 10.1086/521250
HIV/AIDS MAJOR ARTICLE

Pillbox Organizers Are Associated with Improved Adherence to HIV Antiretroviral Therapy and Viral Suppression: A Marginal Structural Model Analysis

Maya L. Petersen,1

Yue Wang,1

Mark J. van der Laan,1

David Guzman,2

Elise Riley,2 and

David R. Bangsberg2,3

1Division of Biostatistics, University of California at Berkeley School of Public Health, University of California at Berkeley, and 2Epidemiology and Prevention Interventions Center, Division of Infectious Diseases, and 3The Positive Health Program, University of California at San Franscisco AIDS Research Institute, San Francisco General Hospital, University of California at San Francisco

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.

Received 20 February 2007; accepted 30 May 2007; electronically published 20 August 2007.

Reprints or correspondence: Dr. David R. Bangsberg, Box 1372, San Francisco General Hospital, UCSF, 1001 Potrero Ave., Bldg.100, Rm. 301, San Francisco, CA 94143‐1372).

Cited by

Jean‐Jacques Parienti, David R. Bangsberg, Renaud Verdon, and Edward M. Gardner. (2009) Better Adherence with Once‐Daily Antiretroviral Regimens: A Meta‐Analysis. Clinical Infectious Diseases 48:4, 484-488
Online publication date: 15-Feb-2009.
Abstract-Full Text-PDF Version (372 kB)
Sheri D. Weiser, Edward A. Frongillo, Kathleen Ragland, Robert S. Hogg, Elise D. Riley, David R. Bangsberg. (2009) Food Insecurity is Associated with Incomplete HIV RNA Suppression Among Homeless and Marginally Housed HIV-infected Individuals in San Francisco. Journal of General Internal Medicine 24:1, 14-20
Online publication date: 1-Feb-2009.
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Michael J. Stirratt, Christopher M. Gordon. (2008) Adherence to biomedical HIV prevention methods: Considerations drawn from HIV treatment adherence research. Current HIV/AIDS Reports 5:4, 186-192
Online publication date: 1-Dec-2008.
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S. R. Cole, M. A. Hernan. (2008) Constructing Inverse Probability Weights for Marginal Structural Models. American Journal of Epidemiology 168:6, 656-664
Online publication date: 15-Aug-2008.
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David R. Bangsberg. (2008) Preventing HIV Antiretroviral Resistance through Better Monitoring of Treatment Adherence. The Journal of Infectious Diseases 197:s3, S272-S278
Online publication date: 15-May-2008.
Abstract-Full Text-PDF Version (187 kB)
Jean B Nachega, Edward J Mills. (2007) Antiretroviral therapy adherence in resource-limited and resource-rich settings: current status of knowledge and research priorities. Therapy 4:6, 775-786
Online publication date: 1-Dec-2007.
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Edward J. Mills and Curtis Cooper. (2007) Editorial Commentary: Simple, Effective Interventions Are Key to Improving Adherence in Marginalized Populations. Clinical Infectious Diseases 45:7, 916-917
Online publication date: 1-Oct-2007.
Citation-Full Text-PDF Version (156 kB)

  • Presented in part: Workshop on HIV Observational Databases, 23–26 March 2006, Madrid, Spain (abstract 90).

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