Point-of-care urine test for assessing adherence to isoniazid treatment for tuberculosis

Soobratty, Mohammad Roshan; Whitfield, Ruth; Subramaniam, Krithika; Grove, Grace; Carver, A.E.; O’Donovan, Grace; Wu, Houdini H.T.; Lee, Oona Y-C.; Swaminathan, R.; Cope, Graham; Milburn, Heather

doi:10.1183/09031936.00132613

Cited by 36 publications

(36 citation statements)

References 8 publications

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“…While the scalability of drug levels to monitor PrEP adherence is unlikely to be feasible using existing technology, point-of-care urine assays for tenofovir are in development. The cost of these assays will likely range from $10 to $20 per test, which may be potentially affordable for PrEP implementation programmes in some settings [ 68 – 70 ].…”

Section: Discussionmentioning

confidence: 99%

PrEP implementation research in Africa: what is new?

Cowan

Delany‐Moretlwe

Sanders

et al. 2016

Journal of the International AIDS Society

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IntroductionOf the two million new HIV infections in adults in 2014, 70% occurred in sub-Saharan Africa. Several African countries have already approved guidelines for pre-exposure prophylaxis (PrEP) for individuals at substantial risk of HIV as part of combination HIV prevention but key questions remain about how to identify and deliver PrEP to those at greatest need. Throughout the continent, individuals in sero-discordant relationships, and members of key populations (sex workers, men who have sex with men (MSM), transgender women and injection drug users) are likely to benefit from the availability of PrEP. In addition, adolescent girls and young women (AGYW) are at substantial risk in some parts of the continent. It has been estimated that at least three million individuals in Africa are likely to be eligible for PrEP according to WHO's criteria. Tens of demonstration projects are planned or underway across the continent among a range of countries, populations and delivery settings.DiscussionIn each of the target populations, there are overarching issues related to (i) creating demand for PrEP, (ii) addressing supply-side issues and (iii) providing appropriate and tailored adherence support. Critical for creating demand for PrEP is the normalization of HIV prevention. Community-level interventions which engage opinion leaders as well as empowerment interventions for those at highest risk will be key. Critical to supply of PrEP is that services are accessible for all, including for stigmatized populations. Establishing accessible integrated services provides the opportunity to address other public health priorities including the unmet need for HIV testing, contraception and sexually transmitted infections treatment. National policies need to include minimum standards for training and quality assurance for PrEP implementation and to address supply chain issues. Adherence support needs to recognize that social and structural factors are likely to have an important influence. Combining interventions that build self-efficacy, empowerment and social cohesion, with evidence-based individualized adherence support for PrEP, are most likely to be effective.ConclusionsEfficacy of tenfovir-based PrEP is proven but many issues related to implementation remain unclear. Here, we have summarized some of the important implementation questions that need to be assessed as PrEP is rolled out across Africa.

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Section: Discussionmentioning

confidence: 99%

PrEP implementation research in Africa: what is new?

Cowan

Delany‐Moretlwe

Sanders

et al. 2016

Journal of the International AIDS Society

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“…isoniazid) or recreational drugs. The cost of these assays range from $10 to $20 per test, which is potentially affordable in the setting of PrEP implementation programmes [73][74][75][76]. The particular components that are included in programmes will depend on context and the stated needs of FSWs in each setting.…”

Section: Addressing Other Challenges To Implementation Of Preexposurementioning

confidence: 99%

Promise and pitfalls of pre-exposure prophylaxis for female sex workers

Cowan

Delany‐Moretlwe

2016

Current Opinion in HIV and AIDS

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“…There is no "gold standard" metric, since all comparators, including biological tests, have their own inaccuracies; examples include inter-and intraindividual variation in drug absorption and metabolism. [68][69][70] We recommend using multiple comparators to gain the fullest understanding of a DAT's accuracy. For example, urine isoniazid testing provides a "snapshot" of dose-taking that can be compared to DAT dosing histories over the prior 24-72 hours, while medication refills provide data on persistence with therapy that can be compared to longer-term dosing histories.…”

Section: Accuracy Of Digital Observationmentioning

confidence: 99%

Digital adherence technologies for the treatment of tuberculosis: landscape and research priorities

Subbaraman¹,

Mondesert²,

Musiimenta³

et al. 2018

Preprint

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Poor medication adherence may increase rates of loss to follow-up, disease relapse, and drug resistance for individuals with active tuberculosis (TB). While TB programs have historically used direct observation of 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- 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 individualized care by TB programs 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 programs and highlight priorities for research.

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Point-of-care urine test for assessing adherence to isoniazid treatment for tuberculosis

Cited by 36 publications

References 8 publications

PrEP implementation research in Africa: what is new?

PrEP implementation research in Africa: what is new?

Promise and pitfalls of pre-exposure prophylaxis for female sex workers

Digital adherence technologies for the treatment of tuberculosis: landscape and research priorities

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