For many of us trying to look on the bright side, throwing back all these vitamins, herbs and antiretrovirals is greatly reminiscent of the madness endured by Neely, Ann and Jennifer, those three sassy starlets from Jacqueline Susann’s immortal The Valley of the Dolls. So in reviewing the latest adherence devices, it was only natural for me to pay tribute to the Pucci-clad authoress and to my favorite pill-popper, Neely O’Hara. Now, close your eyes and hear the soothing strains of Dionne Warwick’s theme song…
“You have to climb Mount Everest to reach the Valley of the Dolls. It’s a brutal climb to reach that peak. You stand there, waiting for the rush of exhilaration, but it doesn’t come. All there is is a feeling of overwhelming…” confusion now that happy hour is complicated with discussions of which is the best cocktail. With 12 approved anti-HIV drugs, the dilemma is how to maintain one’s “pilltini” of choice. Adherence is, as Neely might have said of her reds, key.
Why? Because keeping adequate levels of drug in the blood at all times is the only way to prevent the virus from turning pissy. Since we’re all fallible and forgetful, little mnemonic nudges help us to ensure that we stick to our expensive and tiresome regimens, as the proof is in the pudding—these little alphabetized monsters can keep us healthier if we can keep them down.
Here’s a peek at some pretty little gadgets available to assist all AIDS-y boys and girls in adhering to their regimens. Note: Most of these devices are not prettily priced, so if you’re anything like me, scatter some antiretroviral dolls liberally in the places you find yourself most often, other than home, and if possible, keep at least one dose of everything on hand at all times.
Device: Dosing Partners Maker: Aprex, 800.916.3535 Cost: $69 per month (minimum 3 months’ service), plus a $250 one-time setup fee.
How it works: Uses pill bottles with computerized tops [SmartCaps] that give you a reading of how many times you’ve opened the bottle today and how many hours since the last time. Then, while you sleep, the SmartCap reports this data to a team of nurses via the modem upon which you’ve conveniently stored the bottles. Also provides a monthly adherence report. Advantages: None that Neely can see. Disadvantages: Expensive, complicated and awkward for anyone taking three-plus prescriptions. Plus, it’s hard to pack for your Crixi mountain-climbing trek. However, it would be the ideal system for a rich PWA who’s bedridden with dementia or for a lonely HIVer yearning to chat with corporate nurses.
Device: MedManager Maker: PolyPharm, 248.553.9658 Cost: $45 per month, plus a $50 one-time setup fee
How it works: Computerized pillbox that stores your antiretroviral dolls and tells you when to take them, beeping every 10 minutes until you do. Comes with a Docking Station that delivers your daily data to PolyPharm’s own Nurse Diesel. Each month an adherence report is sent to you and your doc. If you need a report card, this will make you teacher’s pet. Advantages: Pretty pricey, but cute as these things go, and just small enough to fit in your beaded reticule, leaving one hand free to rip off Helen Lawson’s wig. Disadvantages: Not big enough for those of us throwing back pills like M&Ms.
Device: Medicine-on-Time Maker: Medicine-on-Time, 800.722.8824 Cost: Varies depending on pharmacy. Approximate cost is $2 per prescription per month.
How it works: Time-specific dosage cups packaged by a licensed pharmacist. One inch square and 5.8 inches deep, these cups may contain up to six pills for a single administration time, and come on an 8-1/2-by-11-inch card designed like a calendar—you can tear off cups to take with you. Each hermetically sealed cup is labeled with your name, administration time and contents. Advantages: Dirt cheap, this is Neely’s favorite. You always have your instructions and your dolls with you, so you can sparkle, darlings, sparkle! Plus, you won’t annoy others with strange electric noises emanating from your purse or person. Disadvantages: If you’re off on a bender (slumming it “incognito” in some dive with a jukebox), there’s no little electronic nagging to remind you it’s pill time.
Device: MedPrompt Medical Pager Maker: MedPrompt Products, 800.321.7455 Cost: $32.95 per month, plus a $24.95 one-time setup fee
How it works: A Motorola beeper that reminds you when, which and how many meds to take, and any additional special instructions (food restrictions and the like). Advantages: Less expensive than the MedManager. And neat if you fancy styling yourself as a hooker or drug dealer, or just like feeling important being paged. Disadvantages: One more thing to carry, and it doesn’t hold your dolls. Besides which, someone might take you for a hooker or drug dealer.