Smart Phone Medication Adherence Saves Kidneys--SMASK

A randomized RCT will be conducted with kidney transplant patients identified as hypertensive
(>129 SBP following KDIGO guidelines) via medical history. Those identified as being
nonadherent for 4 weeks during the first month post enrollment (adherence score <0.85) will
be eligible to participate in the second phase. Participants in the second phase will be
randomly assigned to standard care (SC) + attention control or the mHealth program plus SC.

Following informed written consent, eligible patients will be asked to complete several brief
surveys aimed at determining, mood state, perceived stress, self-efficacy assessment, comfort
with mHealth devices, perceptions of treatment burden and attitudes towards mhealth. Subjects
will have their blood pressure measured and if SBP is >129 they will enter the screening
phase. Subjects will be provided a Medication dispensing device system. Subjects will be
called the following day to check if there were any problems in filling the Simplemed tray.

The Simplemed has four compartments for each day of the week for potential use.
Microelectronic circuitry in each compartment on the tray date stamps the opening of each
compartment and removal of the refill tray. These signals are relayed via an internal modem
to a server for processing. Data can then be sent directly into the MUSC server that compiles
individuals' health data from multiple delivery points. Adherence rate across the first month
will be calculated at weekly intervals.

All subjects will return for a visit at the end of their 4 week screening period. Those with
an adherence score <0.85 for 4 weeks and whose SBP continues to be >129 will be invited to
participate in the second phase of the RCT. Evaluations performed at this visit will include
anthropometrics, questionnaires, and resting BP. A Spacelabs ABP monitor will be applied with
instructions for wearing the monitor 24 hrs. The subjects will be randomized to SMASK+SC or
SC+ attention control groups after the baseline procedures are completed. Those with med
adherence score ≥0.85 or who have SBP ≤ 129 will return their pill tray but not proceed into
the second phase. Recruitment will end when 80 subjects have successfully transitioned into
the second phase (RCT) of the study.

The SC+ attention control group will continue to use Simplemed with reminder functions
disabled, they will be sent daily text messages or links to PDF documents or videos
containing health information as attention control. The SMASK mhealth intervention group will
also receive SC and have the Simplemed reminder functions turned on (blink for ½ hr when
medication is due, chime additional ½ hr, then text or email after 1 hour) and receive
training in use of the A&D BP monitor. They will be instructed to measure their blood
pressure twice daily AM, PM) on at least every third day. Patients will be provided with and
shown how to use the smart phone app and activate the app when they record their blood
pressure readings.

Inclusion Criteria:

1. ≥21 years old;

2. First time recipient of a functioning solitary kidney transplant;

3. Prescribed ≥3 medications for immunosuppression and HTN;

4. Transplant MD's assent that patient is able to participate;

5. Ability to speak, hear and understand English;

6. Able to take their own BP;

7. Self-administers medications;

8. SBP >129 mmHg at clinic visit(s) in 4 weeks prior, and at initial study evaluation at
enrollment;

9. ***Only subjects with adherence score <.85 after 1-month screening and SBP >129 mmHg
at baseline will be randomized.

Exclusion Criteria:

1. Failure to meet any inclusion criterion;

2. Ongoing substance abuse (e.g., >21 alcoholic drinks/week);

3. Psychiatric illness requiring treatment beyond antidepressants;

4. Will attempt to become pregnant within the year;

5. Pregnant or nursing women, prisoners, and institutionalized persons.