Currently submitted to: Interactive Journal of Medical Research
Date Submitted: Feb 14, 2019
Open Peer Review Period: Feb 19, 2019 - Apr 16, 2019
(currently open for review)
Using Virtual Reality to Improve Antiretroviral Therapy Adherence in the Treatment of HIV
Nonadherence to HIV medications is a serious unsolved problem and is a major cause of morbidity and mortality in the HIV-positive population. Although treatment efficacy is high if compliance is greater than 90%, about 40% of people with HIV do not meet this threshold.
We tested a novel approach to improve medication adherence by using a low-cost virtual reality (VR) experience to educate people with HIV about their illness. We hypothesized that people with HIV would be more likely to be compliant with the treatment following the 7-minute presentation, and therefore should have decreasing viral loads and improved adherence questionnaire scores.
We showed the VR experience to 107 participants with HIV at a county hospital in Los Angeles, California. Participants completed a validated medication adherence questionnaire (MAQ) before and at least two weeks after the VR experience. We also compared viral loads (VL) and cluster of differentiation 4 (CD4) counts before and on average 101 days after the experience. VL were obtained per the clinic’s standard care protocol. Paired t-tests were performed on the initial and follow-up MAQs, VL, and CD4 counts. To reduce the possibility that VL were trending down regardless of the VR experience, two serial VL obtained prior to the experience were also compared and analyzed. Immediately following the VR experience, participants were given a four-question Likert scale questionnaire that assessed their opinions about the experience.
MAQ scores improved from pre- to post- experience with high significance (P = .0001). VL decreased from pre- to post- experience by 0.38 log10 copies/mL (95% CI 0.06 to 0.70; P = .01). In contrast, the two serial VL obtained prior to the experience showed no statistically significant changes. There were no statistically significant changes to CD4 counts. Analysis of the postexperience questionnaire revealed that VR was comfortable for most participants, and that most participants believed the experience to be educational and that it would improve their medication adherence.
The findings suggest that the low-cost VR experience caused an increased rate of antiretroviral therapy adherence that resulted in a decrease of VL. Further studies are required to test whether these results are generalizable to other treatment settings and populations.
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