TOPLINE

Young people with HIV (PWH) who received an electronic monitoring device (EMD) — a digital pillbox that logs medication openings in real time and triggers text message reminders, coupled with monthly adherence feedback — were more likely to achieve viral suppression at 6 months than peers who received enhanced counseling alone; however, the benefit was not sustained 3 months after the device was withdrawn.

METHODOLOGY

• Researchers conducted a randomized trial to assess whether an EMD with text message reminders and monthly adherence feedback improved viral suppression among young PWH in Zimbabwe.
• They included 205 PWH aged 16-30 years (mean age, 22.6 years) who had been on antiretroviral therapy (ART) for at least 6 months and had a viral load > 200 copies/mL.
• Participants were randomly assigned 1:1 into two groups for 6 months: the intervention arm used an EMD — a portable pillbox that tracked when it was opened and sent a text message reminder if it was not opened within 30 minutes of the scheduled ART dose — and received one-on-one adherence feedback sessions; the control arm received enhanced adherence counseling per national guidelines without the device.
• All participants continued routine HIV care and were followed for 9 months (6 months of intervention plus 3 months post-intervention).
• The primary outcome was the proportion of participants with viral suppression (defined as viral load < 50 copies/mL) at 6 months.

TAKEAWAY

• At 6 months, viral suppression was higher in the intervention arm than in the control arm (51.5% vs 36.1%; adjusted risk ratio, 1.39; P = .04).
• However, at 9 months — 3 months after the device was withdrawn — suppression rates were similar between groups.
• Among participants who were virally suppressed at 6 months, viral rebound at 9 months was numerically higher in the intervention arm (41.3% vs 25.8%), though the difference was not statistically significant. The rate of ART regimen switches was lower with the pillbox, but the difference was not statistically significant.
• Five serious adverse events were reported overall: two deaths, two hospitalizations, and one refused hospital admission.

IN PRACTICE

"These findings demonstrate the potential of targeted, multicomponent digital adherence strategies to improve clinical outcomes across diverse health system contexts, while underscoring the need for implementation models that support durability, cost-effectiveness, and integration within comprehensive youth-responsive HIV care," the authors wrote.

SOURCE

The study was led by Nyasha V. Dzavakwa, London School of Hygiene and Tropical Medicine, London, England. It was published online on August 23, 2026, in The Lancet Regional Health - Africa.

LIMITATIONS

The findings may not have applied to all young people because the trial excluded those without their own mobile phone, likely leaving out youths facing more financial and structural barriers to care. Visit frequency also differed between the groups. Moreover, participants may have improved their adherence simply because they knew they were being monitored.

DISCLOSURES

This study was supported under the capacity strengthening scheme of the VITALITY trial, which was funded by the EDCTP2 program supported by the European Union. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.