How digital technologies can empower patients to succeed in TB treatment
Tuberculosis (TB) is still the deadliest infectious disease worldwide, killing over 1.5 million people each year. These deaths are preventable as TB can be cured with appropriate treatment. However, a number of barriers stop patients from recovering from this disease, including long and complicated treatment regimens that involve the daily intake of medicine over the course 6 to 24 months.
By leveraging today’s digital technologies, the Unitaid-funded ASCENT project (Adherence Support Coalition to End TB) aims to support TB patients with their treatment in a modern and more effective way in five countries: Ethiopia, The Philippines, South Africa, Tanzania and Ukraine
At the end of November, the project started in the Philippines where digital adherence technologies were distributed among 32 health facilities and 14 PMDT treatment centers in the provinces of Bulacan and Pampanga. Health facilities are now providing patients who suffer from TB with two innovative tools to support them in their treatment adherence: smart pill boxes and ‘99DOTS’ medication sleeves. Video-supported technologies will also soon be made available.
Digital sleeves - which replace blister packs - automatically provide toll-free phone numbers each time a patient takes a pill. The patient then calls or texts that number which provides health care providers with a digitalised track record of the patient’s treatment.
Smart pill boxes, on the other hand, automatically send a signal to health care facilities each time a patient opens it to take their treatment.
Both technologies aim at improving the remote monitoring of patients’ daily intake of medication.
As of today, 2100 medication sleeves and 404 smart pill boxes have been distributed across the country, and 93 patients have been enrolled. In addition, medication guides have been printed to help TB patients remember what drugs they need to take, while stickers with dosing instructions for drug-sensitive and drug-resistant TB have been placed in the boxes’ inside cover.
At the Arayat Rural Health Unit in the province of Pampanga, Estela Mariano, a 67-year-old patient with TB waits in the queue for her medication refill. She has been using the medication sleeve since the beginning of November 2020 to help her complete her treatment.
Estela Mariano, 67, waits for her medication refill as TB nurse Christine Joy Buan checks on her treatment adherence record on the Everwell adherence platform. Credit : MLMorales/KNCV
“At first, I hesitated to say yes,” she said. “How will a 67-year old widow who is unfamiliar with using a cellphone and finds it difficult to read manage to use such a tool? After the nurse showed me how to use it and gave me step-by-step instructions in Kapampangan, our local dialect, I found that it was easy after all. Following the arrows and the simple illustrations enabled me to take my medication on my own”.
After taking the medicine, the sleeve provides a 3-digits code to be sent by SMS free of charge. “The numbers are written large enough. My grand-daughter sends them for me via phone,” said Estela.
Estela’s grand-daughter shows the DAT system’s message acknowledging receipt of the texted 3-digit code. This indicates that the system has recorded Estela’s medication intake as a dose taken. Credit : MLMorales/KNCV
A message acknowledging receipt is then sent automatically by the digital adherence technology (DAT) platform of the Arayat Rural Health Unit 1-iDOTS, which centralises all the data.
On the other side of the counter at the health unit, nurse Christine Joy Buan receives daily reminders through the DAT platform whenever a patient misses a dose. When that happens, she then promptly texts or calls to encourage them to continue to take their medication.
“This is a great improvement. Before we had the DAT system, it took me more than a month to discover that a patient had interrupted a treatment, which could lead to unfavorable outcomes.” Importantly, she notes, “it reduces the frequency of face-to-face interaction, which became a distinct advantage in times of COVID-19”.
According to the information recorded in the DAT platform, Estela has a 90% adherence rate as of December 2nd, 2020.
Learn more about the potential of digital technologies by listening here to the full interview of Kristian Van Kalmthout, ASCENT’s project director for the KNCV Tuberculosis Foundation.
The ASCENT project runs from July 2019 until December 2022 by a consortium led by the KNCV Tuberculosis Foundation including PATH, the Aurum Institute and the London School of Hygiene and Tropical Medicine. It aims to reach nearly 70,000 patients in the five targeted countries.
It focuses on the following outputs:
- Facilitating country adoption and uptake of digital adherence technologies;
- Generating crucial evidence for optimal use and scale;
- Creating a global market and implementation plan for digital adherence technologies.