China Adherence for Life (China AFL) Study

Project Description

To be successful, antiretroviral therapy (ART) requires that HIV-positive patients take the medication consistently—every day and at the same times. Missing or incorrect timing of more than 10% of ART doses is linked to clinical progression to AIDS or death, and the development and spread of drug-resistant HIV.

The China Adherence for Life study’s primary goal was to pilot-test the short-term efficacy of a simple intervention: providing HIV-positive patients with their adherence data from the previous month and using these data in monthly counseling sessions. The adherence information was generated by electronic drug monitors (EDM), pill bottles outfitted with time-measuring computer chips embedded in the caps, considered a reliable proxy for actual pill-taking. The study was designed to assess whether providing patients with these data and counseling informed by the data (“EDM feedback”) would improve the effectiveness of adherence counseling and thereby increase ART adherence.

Once a month, when patients came to the clinic to get their medication, the caps of their pill bottles were scanned to retrieve data about when bottles had been opened. This allowed the researchers to monitor precisely when patients took their drugs throughout the study. Patients in the control group consulted with their doctors as usual and were not given data about their compliance patterns. In the intervention arm, patients and doctors received a printout of the drug adherence pattern from the previous month and discussed the results together.

After 6 months of the intervention, among 64 subjects who completed the trial, mean adherence had risen significantly among study subjects who received the EDM feedback intervention from 86.8% to 96.5%. Mean adherence remained unchanged in control subjects. The study team concluded that this approach appeared promising and should be tested more widely in China and in other settings.

Boston University is a member of the World Health Organization Collaborating Center on Pharmaceutical Policy (WGOCCP).

This project is one activity of the CGHD’s Child and Family Applied Research project (CFAR).

Project Details

Principal Investigator Lora Sabin
Boston University Co-Investigators Mary Bachman DeSilvaDavidson Hamer, Christopher Gill
  • Ditan Hospital (Beijing, China)
  • Xu Keyi, Ditan Hospital (Beijing, China)
  • Yuan Yue & Fang Wen, Horizon Research Group
  • Li Tao
  • Zhang Jianbo, Dali Second People’s Hospital
Country(ies) China
Dates of Research 2005–2008
Donor/Funder USAID logo United States Agency for International Development (USAID)