Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities. Issue 5 (11th October 2018)

• Record Type: Journal Article
• Authors: Subbaraman, Ramnath; de Mondesert, Laura; Musiimenta, Angella; Pai, Madhukar; Mayer, Kenneth H; Thomas, Beena E; Haberer, Jessica
• Is Part Of: BMJ global health. Volume 3:Issue 5(2018)
• Publication Date: 2018-10-11
• Subjects: tuberculosis -- medication adherence -- differentiated care -- SMS reminders -- mhealth -- mobile technologies -- electronic medication packaging devices -- digital medication monitors; World health -- Periodicals; 362.105
• DOI: 10.1136/bmjgh-2018-001018
• Languages: English
• ISSNs: 2059-7908

Abstract

Abstract : Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy (DOT) to address adherence, concerns have been raised about the patient burden, ethical limitations, effectiveness in improving treatment outcomes and long-term feasibility of DOT for health systems. Digital adherence technologies (DATs)—which include feature phone–based and smartphone-based technologies, digital pillboxes and ingestible sensors—may facilitate more patient-centric approaches for monitoring adherence, though available data are limited. Depending on the specific technology, DATs may help to remind patients to take their medications, facilitate digital observation of pill-taking, compile dosing histories and triage patients based on their level of adherence, which can facilitate provision of individualised care by TB programmes to patients with varied levels of risk. Research is needed to understand whether DATs are acceptable to patients and healthcare providers, accurate for measuring adherence, effective in improving treatment outcomes and impactful in improving health system efficiency. In this article, we describe the landscape of DATs that are being used in research or clinical practice by TB programmes and highlight priorities for research.