Innovations in Drug Adherence

This past weekend (April 16-17) saw more than 2000 students, doctors, public health professionals, policy makers, activists, scientists, venture capitalists and philanthropists (and others!) descend on New Haven, CT for the [Unite for Sight Global Health & Innovation Conference]( held at Yale University. Participants hailed from all 50 states and more than 55 countries. Session topics ranged from presentations on maternal and child health, to workshops on innovation dissemination to social enterprise pitches. Unsurprisingly, one topic that surfaced frequently was the use of technology and point-of-care diagnostics. Here is one of the presentations that stood out most to the author:

**"Wireless Adherence Monitoring Technology,"** _presented by **Jessica Haberer**, MD, MS, Research Scientist, Harvard Institute for Global Health; Assistant in Health Decision Sciences, Massachusetts general hospital; Instructor, Harvard Medical School_

Dr. Jessica Haberer focused her presentation on the fact that, even in developed countries, only about 50% of patients adhere to medications for chronic diseases. To deal with this, a number of monitoring practices have been developed, from more subjective self-reporting by patients, to more objective pill counts, reporting of pharmacy data and testing of drug levels. Nevertheless, all of these standard monitoring practices detect lack of adherence too late which can have serious clinical consequences for the patient. New technologies can help in three ways:

1. **Mobile phones** allow patients to report their adherence through live calls, text message and interactive voice response. The ease of use of mobile phones means that patients can report more frequently and immediately after they take their dose, which helps solves problem of recall bias (forgetting details). In addition, the use of mobile phones can be desirable due to the anonymity that they provide. Still, phones do have their limitations. For example, the use of mobile phones depends on network availability and user understanding of the technology itself. In addition, identification problems can arise when phones are shared, as is often the case in developing countries.

2. **Wireless pill containers** offer an interesting alternative to mobile phones. In this case, patients take their pills from a special container whose cap contains an SMS chip and can alert a health worker every time the container is opened. Current versions of this technology have batteries that last for approximately three months. Early pilots have shown high levels of acceptance of this technology in developing countries, however this option is limited by the high cost per device (USD$100-200). Check out [On Cue Compliance]( for an example in the CHMI database of wireless pill containers in use.

3. **Wireless Ingestion Monitors** represent the most futuristic and high tech of the three options. New technology created by [MagneTrace]( uses a specially designed necklace and a magnetize pill to detect when a pill has passed through the esophagus. Alternatively, [X out TB]( employs special strips of paper that react with metabolites in the patient’s urine (which are only present after ingestion of a pill) to reveal a code that the patient must then text in to a health worker. Other technologies can detect metabolites on the patient’s breath. These types of solutions hold great promise, but at the moment they are prohibitively expensive and require a significant level of coordination with the drug manufacturers themselves.

In Dr. Haberer’s opinion, while there have been a number of successes in all three of these regions, wireless pill containers seem to hold the most promise for the moment. Nevertheless, only time and testing will reveal which solution is most effective or if any new solutions will step in to save the day.