Trial Information

Novel Approaches to Monitoring and Utilizing Adherence to HIV Therapy in Uganda

The investigators will study use a novel method of real-time wireless adherence monitoring
in one of the best established multi-disciplinary HIV antiretroviral treatment cohorts in
rural Africa. The investigators will advance our theoretical understanding of HIV
antiretroviral adherence behavior, HIV pathogenesis, and to address the monitoring and
prevention of HIV antiretroviral treatment failure. Based on a successful pilot study in
rural Uganda and favorable cost-effective estimates, the investigators will deploy the
Wisepill real-time wireless adherence monitoring system to objectively monitor adherence in
real time. The investigators will determine to what extent social capital mitigates economic
barriers to long-term adherence and determine if the pervasive impact of stigma on adherence
operates through social capital (Aim 1). The investigators will determine the relationship
between missed doses, low-level viremia (between 1 and 50 copies RNA/mL), inflammation,
bacterial translocation, suboptimal CD4 response, and mortality (Aim 2). Finally, The
investigators will examine the relationship between complex adherence patterns and viral
failure to both inform selective viral load monitoring and to lay the foundation for the
first-of-kind intervention to prevent viral failure after missed doses, but before viral
rebound (Aim 3). The investigators will secure behavioral and biologic data over nine years
of potential treatment by recruiting 500 additional people to our existing cohort in
Mbarara, Uganda for a total of 775 participants.