Medication Event Monitoring System for Infectious Tuberculosis Treatment in Morocco: A Retrospective Cohort Study

Park, Seup; Sentissi, Ilham; Gil, Seung Jae; Park, Won Seok; Oh, Byung Kwon; Son, Ah Reum; Kong, Young Ju; Park, Sol; Paek, Eunseong; Park, Yong Joon; Lee, Seung Heon

doi:10.3390/ijerph16030412

Cited by 31 publications

(33 citation statements)

References 17 publications

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“…The new TB patients may have stronger confidence and determination to cure the disease which facilitate them to take anti-tuberculosis medicine in time and quantity; however, the relapse patients may hold the idea that the disease would recur even it is cured temporarily and they may also require more complicated treatment, so they could take medicine not seriously. 33,34 In a previous study, medication duration was significantly negatively associated with medication adherence, 35 but the association in our study was not significant (p=0.090), which may be due to regional differences. Additionally, the number of anti-TB drugs patients took and whether they only took free anti-TB drugs were not associated with medication adherence.…”

Section: Discussioncontrasting

confidence: 89%

<p>Determinants of Medication Adherence for Pulmonary Tuberculosis Patients During Continuation Phase in Dalian, Northeast China</p>

Chen

Zhu

et al. 2020

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Purpose: Medication adherence is crucial for decreasing the burden of tuberculosis, but few relevant studies have been conducted in northeast China. This study aimed to explore the level of medication adherence among pulmonary tuberculosis outpatients and the predictive factors based on the bio-psycho-social medical model. Patients and Methods: A cross-sectional multi-center survey was conducted in four tuberculosis medical institutions in Dalian, northeast China. Medication adherence was measured using the eight-item Chinese version of the Morisky Medication Adherence Scale, which divides adherence into three levels. The independent variables consisted of sociodemographic characteristics, treatment factors, knowledge about TB, mental health, and behavioral characteristics. Descriptive statistics, the chi-square test, and multivariate ordinal logistic regression were applied to analyze the data using Stata/MP 14.0. Results: Among the 564 eligible participants, 236 (41.84%) and 183 (32.45%) exhibited high and medium medication adherence, respectively, but 145 (25.71%) exhibited low medication adherence. Multivariate ordinal logistic regression showed that patients who were older (OR: 1.02, p=0.013) were employed (OR: 1.61, p=0.011), had better tuberculosis knowledge (OR: 1.34, p<0.001), and did not consume alcohol (OR: 1.84, p=0.032) exhibited higher medication adherence. However, patients who did not follow their doctors' advice to take adjuvant drugs (OR: 0.44, p=0.001), had a history of TB treatment (OR: 1.76, p=0.009), experienced adverse drug reactions (OR: 0.65, p=0.017), experienced stigma (OR: 0.67, p=0.032), and needed supervised treatment (OR: 0.66, p=0.012) exhibited lower medication adherence. Conclusion: Tuberculosis patients' medication adherence was not very high and it was influenced by diverse and complex factors involving sociodemographic characteristics, treatment factors, knowledge about TB, mental health, and behavioral characteristics.

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Section: Discussioncontrasting

confidence: 89%

<p>Determinants of Medication Adherence for Pulmonary Tuberculosis Patients During Continuation Phase in Dalian, Northeast China</p>

Chen

Zhu

et al. 2020

PPA

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“…Meanwhile, our findings are in contrast to the study from Morocco and South African. In rural Morocco, a medication event monitoring system with SAT increased treatment success and decreased the loss to follow-up among people with new smear positive pulmonary TB when compared to SAT alone, but only age, sex and health facility were adjusted for while deriving the adjusted measures of association [ 12 ]. Another study in South Africa, using SIMpill system (real time data communication with a web-based application by SMS every time the patient opens the bottle) also found that TB cure rates improved compared with control group, but the study did not describe the management approach of control group, and only 24 people were involved in the EMM group [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…SAT alone, but only age, sex and health facility were adjusted for while deriving the adjusted measures of association [12]. Another study in South Africa, using SIMpill system (real time data communication with a web-based application by SMS every time the patient opens the bottle) also found that TB cure rates improved compared with control group, but the study did not describe the management approach of control group, and only 24 people were involved in the EMM group [19].…”

Section: Plos Onementioning

confidence: 99%

“…Thus, the EMMs are looked as accessible and affordable solutions for adherence monitoring in resource-limited settings [ 4 ]. In rural Morocco, medication event monitoring system (real time data shared by monitoring the weight of drugs in the medication monitor) with SAT increased treatment success and decreased the loss to follow-up when compared to SAT alone [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Do electronic medication monitors improve tuberculosis treatment outcomes? Programmatic experience from China

et al. 2020

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Background In China, an indigenously developed electronic medication monitor (EMM) was used. EMM recorded each time the device was opened (no real time data), offering an indirect measure of tuberculosis treatment adherence. Previous study in China showed that the EMM uptake was satisfactory, missing adherence data were common in the information management system (25%) and shift to directly observed therapy (DOT) based on poor adherence documented by EMMs were seldom. Objectives Among people with tuberculosis notified in 30 counties (July-December 2018) where EMM supported self-administered therapy (SAT) was suggested to all eligible (no communication impairment, ambulatory), we assessed the relative differences in unfavourable outcomes and deaths among those started on EMM at baseline (within first month of diagnosis) when compared to SAT alone. Methods This was a cohort study using secondary data. We employed an intention to treat analysis, and used modified Poisson regression with robust variance estimates to assess the association. Results Of 1810 eligible people, 1047 used EMM at baseline and of them, 216 (20.1%) stopped using EMM midway. Of 763 people who did not use EMM at baseline, 267 (35.0%) started using EMM later during the treatment. Among those who started using EMM at baseline, 6.3% [95% CI: 4.9, 8.0] had unfavourable outcomes compared to 6.7% [95% CI: 5.1, 8.8] among those who did not (p = 0.746). Lesser deaths were observed in people who started EMM at baseline when compared to those who did not: 2.5% [95% CI: 1.7, 3.7] versus 3.5% [95% CI: 2.4, 5.2], p = 0.191. The lack of association remained after adjusting for potential confounders (occupation, TB classification and TB category). Conclusion Under programmatic settings, we did not find significant differences in the outcomes. Optimization of EMMs by shifting to DOT when indicated, addressing the issue of missing data and ensuring continuous use is required.

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“…Our findings are consistent with other EMM studies that provided real-time data. In rural Morocco, EMM (that provide a real-time data) increased treatment success and decreased the lost to follow-up among people with new smear positive pulmonary TB when compared to SAT alone [20]. Another study in South Africa, using SIMpill system (real-time data communicated with a web-based application by SMS every time the patient opens the bottle), also found that TB cure rates improved compared with the control group.…”

Section: Interpretation Of Key Findingsmentioning

confidence: 96%

Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study

et al. 2021

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Background In China, an indigenously developed electronic medication monitor (EMM) was designed and used in 138 counties from three provinces. Previous studies showed positive results on accuracy, effectiveness, acceptability, and feasibility, but also found some ineffective implementations. In this paper, we assessed the effect of implementation of EMMs on treatment outcomes. Methods The longitudinal ecological method was used at the county level with aggregate secondary programmatic data. All the notified TB cases in 138 counties were involved in this study from April 2017 to June 2019, and rifampicin-resistant cases were excluded. We fitted a multilevel model to assess the relative change in the quarterly treatment success rate with increasing quarterly EMM coverage rate, in which a mixed effects maximum likelihood regression using random intercept model was applied, by adjusting for seasonal trends, population size, sociodemographic and clinical characteristics, and clustering within counties. Results Among all 69 678 notified TB cases, the treatment success rate was slightly increased from 93.5% [95% confidence interval (CI): 93.0–94.0] in second quarter of 2018 to 94.9% (95% CI: 94.4–95.4) in second quarter of 2019 after implementing EMMs. There was a statistically significant effect between quarterly EMM coverage and treatment success rate after adjusting for potential confounders (P = 0.0036), increasing 10% of EMM coverage rate will lead to 0.2% treatment success rate augment. Besides, an increase of 10% of elderly or bacteriologically confirmed TB will lead to a decrease of 0.4% and 0.9% of the treatment success rate. Conclusions Under programmatic settings, we found a statistically significant effect between increasing coverage of EMM and treatment success rate at the county level. More prospective studies are needed to confirm the effect of using EMM on TB treatment outcomes. We suggest performing operational research on EMMs that provides real-time data under programmatic conditions in the future.

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Medication Event Monitoring System for Infectious Tuberculosis Treatment in Morocco: A Retrospective Cohort Study

Cited by 31 publications

References 17 publications

<p>Determinants of Medication Adherence for Pulmonary Tuberculosis Patients During Continuation Phase in Dalian, Northeast China</p>

<p>Determinants of Medication Adherence for Pulmonary Tuberculosis Patients During Continuation Phase in Dalian, Northeast China</p>

Do electronic medication monitors improve tuberculosis treatment outcomes? Programmatic experience from China

Effect of using electronic medication monitors on tuberculosis treatment outcomes in China: a longitudinal ecological study

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