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Professor
Catherine Orrell

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Profile EDCTP Fellowship 1 EDCTP Fellowship 2

Project Title

Improving RETention and viral load outcomes for people taking Antiretroviral therapy through early IdentificatioN of missed doses [The RETAIn study].

EDCTP Project

TMA2019SFP-2812

EDCTP Program

EDCTP2

EDCTP Project Call

Senior Fellowship Plus (SFP)

Host Organisation

Department Institution Country

Project Title

 A randomised controlled trial of real-time electronic adherence monitoring with text message dosing reminders in people starting first-line antiretroviral therapy

EDCTP Project

 TA.2011.40200.015

EDCTP Program

EDCTP1

EDCTP Project Call

Senior Fellowship (SF)

Project Objectives

This study will use a locally developed real time adherence monitoring tool to explore and improve adherence in ART-naïve individuals commencing treatment in an established ART cohort. The study will use adherence, virological and pharmacokinetic data to examine adherence failure discordance. The questions to be answered by the study are: 1. Does a real-time electronic adherence monitoring tool with text message feedback improve adherence, retention in care and virological outcomes among ART-naïve individuals receiving first-line therapy? 2. Does population pharmacokinetic data explain discordance between adherence and virological response?

Study Design

A randomised controlled trial with two arms, as follows: Control arm: Standard of care at ART clinic with use of an electronic adherence monitoring device (EAMD or Wisepill) to monitor adherence only (i.e., without any feedback). Experimental group: Control arm with the addition of the use of the EAMD text message service when dosing late, and EAMD dosing feedback at 4-monthly visits.

Host Organisation

Department Institution Country
University of Cape Town South Africa

Sites

Results & Outcomes

Research activities: Study recruitment and follow-up was completed with 186 participants completing the study, 19 lost to follow-up, 16 transferred elsewhere , 1 withdrawing consent and 8 dying. Cytochrome 2B6 genotyping and PK sample analysis have been completed and results received. Data analysis is on-going for the primary study outcome. Three manuscripts are underway (one on the primary outcome, namely adherence according to the Wisepill device by randomised arm; one covering the pharmacokinetic and pharmacogenetic results; and one comparing the impact of the different adherence measures used during the study on virological suppression. An abstract for the Conference on Retroviruses and Opportunistic Infections (CROI) has been drafted is to be submitted for presentation in February 2015. Analysis of baseline data was completed and will be presented at the 2014 EDCTP forum (Berlin) Capacity Building: The PI, Dr Catherine Orrell, completed three semesters of training in Biostatistics through the School of Public Health at the University of Cape Town (UCT) in 2012 and 2013. She is also registered for a PhD in the Department of Medicine at UCT. Three counsellors have been trained in in good clinical practice (GCP) and are receiving advanced counselling training in 2014/15. This will enable them become research assistants which will greatly improve their future employment prospects. Several study results or outcomes meetings have been held with clinical site staff Networking: New collaborations have been developed with : Prof Nick Holford from University of Auckland who will provide expertise on efavirenz population pharmacokinectic modelling. Prof David Haas at van der Bilt University, USA, whose expertise will be used to explore the use of genotypes to better understand individual ART levels. Funding: The fellow received a discovery foundation academic fellowship award in 2012.