Patient-centered mobile tuberculosis treatment support tools (TB-TSTs) to improve treatment adherence: A pilot randomized controlled trial exploring feasibility, acceptability and refinement needs

Iribarren, Sarah J.; Milligan, Hannah; Chirico, Cristina; Goodwin, Kyle; Schnall, Rebecca; Telles, Hugo; Iannizzotto, Alejandra; Sanjurjo, Myrian; Lutz, Barry; Pike, Kenneth L.; Rubinstein, Fernando; Rhodehamel, Marcus; Leon, Daniel A. Carranza; Keyes, Jesse; Demiris, George

doi:10.1016/j.lana.2022.100291

Cited by 6 publications

(7 citation statements)

References 30 publications

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Section: Discussionmentioning

confidence: 99%

“…[19,20,29,48,52] Similarly, for interventions that involved smartphone technologies, most studies described various combinations of associated measures e.g., medication reminders, adverse event reporting, instant messaging, chat groups with providers and/or other patients. [37,53,54] The diversity of comparison strategies reported as the "standard of care" further complicates This substantially limits generalizability of findings regarding these two technologies to lowerincome country settings where TB burden is highest, yet where these technologies and the necessary technical and human resource infrastructure may be least accessible. Notably, however, our review does report robust findings from studies in LMICs: the DAT types implemented in these settings (e.g., SMS, 99DOTS, digital pillboxes) had variable or nonsignificant impacts on treatment outcomes, which has important policy implications.…”

Section: Discussionmentioning

confidence: 99%

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The Impact of Digital Adherence Technologies on Health Outcomes in Tuberculosis: A Systematic Review and Meta-Analysis

Mohamed,

Zary,

Kafie

et al. 2024

Preprint

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Background: Suboptimal tuberculosis (TB) treatment adherence may lead to unsuccessful treatment and relapse. Digital adherence technologies (DATs) may allow more person-centric approaches for supporting treatment. We conducted a systematic review (PROSPERO- CRD42022313166) to evaluate the impact of DATs on health outcomes in TB. Methods: We searched MEDLINE, Embase, CENTRAL, CINAHL, Web of Science and preprints from medRxiv, Europe PMC, and clinicaltrials.gov for relevant literature from January 2000 to April 2023. We considered experimental or cohort studies reporting quantitative comparisons of clinical outcomes between a DAT and the standard of care in each setting. Results: Seventy studies (total 58,950 participants) met inclusion criteria. They reported SMS-based interventions (k=18 studies), feature phone-based interventions (k=7), medication sleeves with phone calls (branded as “99DOTS,” k=5), video-observed therapy (VOT; k=17), smartphone-based interventions (k=5), digital pillboxes (k=18), ingestible sensors (k=1), and interventions combining 2 DATs (k=1). Overall, the use of DATs was associated with more frequent treatment success in TB disease (OR = 1.18 [1.06, 1.33]; I2 = 66%, k = 46), a decrease in loss to follow up (OR = 0.71 [0.53, 0.94]; I2 = 80%, k = 36) and an increase in adverse event reporting (OR = 1.53 [1.26, 1.86]; I2 = 0%, k = 9). VOT was associated with an increased likelihood of treatment success in TB disease (OR 1.54 [1.09; 2.19]; I2 = 0%, k = 8) and treatment completion in TB infection (OR 4.69 [2.08; 10.55]; I2 = 0%, k = 2) as well as an increased frequency of adverse event reporting (OR = 1.79 [1.27; 2.52]; I2 = 34%, k = 4). Other interventions involving smartphone technologies were associated with increased treatment success in TB disease (OR 1.98 [1.07; 3.65]; I2 =56%, k = 5) and a decreased frequency of loss to follow up(OR = 0.31 [0.13; 0.77]; I2 = 36%, k = 5). Digital pillboxes were also associated with an improvement in treatment success (OR = 1.32 [1.00; 1.73]; I2 = 71%, k = 11). However, improved treatment success was only seen in high- and upper middle-income countries. SMS-based interventions, feature-phone interventions and 99DOTS were not associated with improvements in short-term clinical outcomes. Conclusion: Certain DATs--notably VOT and smartphone-based interventions, in higher income settings and sometimes combined with other supportive measures—may be associated with improvements in treatment success and losses to follow-up, compared to standard care. However, evidence remains highly variable, and generalizability limited. Higher quality data are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Impact of Digital Adherence Technologies on Health Outcomes in Tuberculosis: A Systematic Review and Meta-Analysis

Mohamed,

Zary,

Kafie

et al. 2024

Preprint

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“…[INSERT FIGURE 3] The plot summarises the percentage of DAT engagement over total dose days for 54 observations from 41 studies included in this analysis. Studies included for SMS interventions [16,24,26,27]; Phone [28,29]; 99DOTS [15,[30][31][32]; Pillboxes [10,15,16,20,[33][34][35][36][37][38][39][40]; VST [15,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]; and Ingestion Sensors [61]. For Wei (2024) and Liu (2015) pillbox openings were supplemented with pill counts so not all adherence was measured based on engagement with the digital adherence technology [10,…”

Section: Reach C-sustained Dat Engagement By People With Tbmentioning

confidence: 99%

Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework

Chilala,

Foster,

Bahukudumbi

et al. 2024

Preprint

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IntroductionGlobally, tuberculosis (TB) remains one of the leading infectious causes of death, with 1.3 million deaths. Digital adherence technologies (DATs) have the potential to provide person-centred care and improve outcomes. Using the RE-AIM framework, we conducted a scoping review of DAT implementations for TB treatment.MethodsWe searched eight databases for papers published between January 2000 and April 2023, using keywords for ‘tuberculosis’ and ‘digital adherence technology’. Articles meeting prespecified inclusion criteria and containing data on RE-AIM domains were included (PROSPERO-CRD42022326968). We defined ‘reach’ as comprising cellphone ownership and engagement by people with TB (PWTB) with DATs, ‘adoption’ as engagement by healthcare providers with DAT programs, ‘implementation’ as the fidelity of the DAT program implemented, and ‘maintenance’ as longer-term uptake of DATs.ResultsOf 10,313 records, 105 contributed to the synthesis. DATs included SMS, phone, 99DOTS, video-supported therapy and pillboxes. For ‘reach’, across various settings, cellphone access varied from 50-100% and 2-31% of PWTB were excluded from accessing DATs due to technology challenges. 36-100% of PWTB agreed to use a DAT. The weighted mean of DAT engagement over dose-days was 81% for SMS, 85% for phone, 61% for 99DOTS, 87% for pillbox and 82% for VST. Concerning ‘implementation’, the fidelity of DAT implementations was affected by technological issues such as cellphone coverage, DAT malfunction and provider-facing issues; including failure to initiate intensified patient management following low DAT engagement. Findings related to RE-AIM dimensions of ‘adoption’ and ‘maintenance’ were limited.ConclusionOur findings suggest that the ‘reach’ of DATs may be limited by a cascade of barriers, including limitations in cellphone accessibility and suboptimal sustained DAT engagement by PWTB. Video and pillbox DATs have higher levels of engagement. Implementation challenges included technological and provider-facing issues. Improving implementation outcomes may be important for TB DATs to achieve broader public health impact.

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“…The DATs used in Tanzania include a District Health Information Software 2 Tracker (DHIS2 Tracker), a web-based application that helps data collection and analysis of transactional data. The DATs are a patient-centric approach and have shown great importance in TB health care delivery services (Iribarren et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

SmartTB: An Integrated Digital Patient-Centric Tool for Promoting Adherence to Treatment among People Living with TB in Tanzania

Mnyambo,

Barakabitze

2023

EAJSTI

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Tuberculosis (TB) is one of the most common killer diseases in Tanzania. The WHO report shows that a person infected with TB bacteria can be treated and prevented. During treatment, TB patients are required to visit a health facility to take medication. A 6-month course of drug treatment has been shown to successfully treat approximately 85% of infected individuals and reduce transmission of the disease. Despite this, there is a high rate of TB patients who discontinue treatment, consequently forgetting to visit the clinics at the required appointments to take medication. In this context, TB patients remain ill for a long time, which leads to drug-resistant TB. In addition, DOT nurses have difficulty identifying TB patients who miss a dose and are therefore unable to follow up by phone or home visits. This results in poor reporting that delays decision-making for TB management. The application of digital technologies such as artificial intelligence in healthcare has shown potential in healthcare services, including TB treatment and monitoring. In an effort to improve and maintain the quality of TB care, we have developed an integrated digital patient-centric tool called SmartTB that promotes treatment adherence among people living with TB in Tanzania and supports real-time reporting and monitoring. Using the agile methodology, requirements analysis was acquired from three hospitals in Tanzania, and user acceptance testing was implemented to validate the performance of the system before launch. The validation results show that SmartTB can improve TB treatment, monitoring, and reporting. Therefore, policymakers must consider the use and integration

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Patient-centered mobile tuberculosis treatment support tools (TB-TSTs) to improve treatment adherence: A pilot randomized controlled trial exploring feasibility, acceptability and refinement needs

Cited by 6 publications

References 30 publications

The Impact of Digital Adherence Technologies on Health Outcomes in Tuberculosis: A Systematic Review and Meta-Analysis

The Impact of Digital Adherence Technologies on Health Outcomes in Tuberculosis: A Systematic Review and Meta-Analysis

Implementation outcomes of tuberculosis digital adherence technologies: a scoping review using the RE-AIM framework

SmartTB: An Integrated Digital Patient-Centric Tool for Promoting Adherence to Treatment among People Living with TB in Tanzania

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