Objective Medication nonadherence contributes to significant morbidity and mortality worldwide. While many techniques to measure adherence exist, digital pill systems represent a novel, direct method of measuring adherence and a means of providing instantaneous adherence supports. In this narrative review, we discuss digital pill system research based on clinical trials and qualitative investigations conducted to date and potential future applications of digital pill system in medication adherence measurement. Methods We conducted a literature search in PubMed of English language peer-reviewed articles describing the use of digital pill system for medication adherence measurement between 2000 and 2021. We included all articles that described the deployment of ingestible sensors and those involving qualitative investigations of digital pill system with human subjects. Results A total of 95 articles were found on initial search; 75 were removed based on exclusion criteria. Included articles were categorized as investigations that deployed an ingestible sensor in human populations ( n = 18), or those that conducted qualitative work ( n = 3). For pilot studies, the mean accuracy of the sensor to successfully detect a medication ingestion event ranged from 68% to 100%. When digital pill systems were deployed in real-world clinical settings, accuracy ranged from 68% to 90% with lower accuracy due to nonadherence to digital pill system technology. Qualitative studies demonstrated that providers and patients perceive the digital pill system as a facilitator for improving adherence and as a potential platform for delivering adherence interventions. Additionally, ingestion data from digital pill system was viewed as useful in facilitating adherence discussions between clinicians and patients. Conclusions This narrative review demonstrates that the use of digital pill system is broadly feasible across multiple disease states including human immunodeficiency virus, hepatitis C infection, solid organ transplants, tuberculosis, schizophrenia, cardiovascular disease, and acute fractures, where adherence is closely linked to significant morbidity and mortality. It also highlights key areas of research that are still needed prior to broad-scale clinical deployment of such systems.
Background India has the greatest burden of tuberculosis (TB). However, over 15% of the people on antitubercular therapy (ATT) in India are nonadherent. Several adherence monitoring techniques deployed in India to enhance ATT adherence have had modest effects. Increased adoption of mobile phones and other technologies pose potential solutions to measuring and intervening in ATT adherence. Several technology-based interventions around ATT adherence have been demonstrated in other countries. Objective The objective of our study was to understand the acceptance of mobile phone adherence supports for ATT using self-administered quantitative measures among patients with TB in South India. Methods This exploratory study was conducted at a TB treatment center (TTC) at a tertiary care center in Thrissur District, Kerala, India. We recruited 100 patients with TB on ATT using convenience sampling after obtaining written informed consent. Trained study staff administered the questionnaire in Malayalam, commonly spoken in Kerala, India. We used frequency, mean, median, and SD or IQR to describe the data. Results Of the 100 participants diagnosed with TB on ATT, 90% used mobile phones routinely, and 84% owned a mobile phone. Ninety-five percent of participants knew how to use the calling function, while 65% of them did not know how to use the SMS function on their mobile phone. Overall, 89% of the participants did not consider mobile phone–based ATT adherence interventions an intrusion in their privacy, and 93% did not fear stigma if the adherence reminder was received by someone else. Most (95%) of the study participants preferred mobile phone reminders instead of directly observed treatment, short-course. Voice calls (n=80, 80%) were the more preferred reminder modality than SMS reminders (n=5, 5%). Conclusions Mobile phones are likely an acceptable platform to deliver ATT adherence interventions among individuals with TB in South India. Preference of voice call reminders may inform the architecture of future adherence interventions surrounding ATT in South India.
Background: Dengue is one of the most rapidly spreading mosquito-borne viral diseases in the world. Aedes aegypti mosquito is the main vector of dengue and Chikungunya. Entomological surveillance on Aedes mosquito has been standardized on different indices like House index, Container index, Breteau index. Larval indices are important predictors of outbreaks and are valuable in taking preventive measures. The objectives of the present study was to study the trend of larval indices over four months in selected wards of Kaiparambu Panchayat, Thrissur, Kerala, India and to identify the major breeding sources.Methods: A series of surveys were conducted from May to August of 2017 in Kaiparambu Panchayat under the field practice area of Amala Institute of Medical Sciences Thrissur. Houses were selected serially from 4, 5 and 6 wards with roughly 120 houses being covered each month.Results: A total of 489 houses were surveyed over 4 months. Overall, positive containers (with larvae) were present in 375 of 4055 potential containers showing a calculated House index (HI) is 44.4%, Container index (CI) is 11.5% and the Breteau Index is 76.7%. All three indices increased from May to June, peaked in July and dropped by August. Plastic containers were the most common source of breeding.Conclusions: The indices indicate risk even in the pre-monsoon season and there is a marked rise during monsoon. Hence, control measures need to be adopted during the pre-monsoon season so as to reduce the impact of the impending outbreak.
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