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

Abstract

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.

Digital adherence technologies to improve tuberculosis treatment outcomes in China: a cluster-randomised superiority trial

“…This trial did show a reduction in non-adherence, measured by box-opening, in the intervention group compared with the control group, similar to in our previous study, 6 indicating improved quality of treatment with the intervention. Based on adherence data from these two pragmatic trials and programmatic experience of medication event reminder monitors in 138 counties in China, 21 the China national tuberculosis programme has planned to expand the utilisation of the monitors, albeit with real-time functions, nationwide, in their 14th 5-year plan (for 2021–25).…”

Mapping the effectiveness of the community tuberculosis care programme: A systematic review

“…The thirty-six included studies were published between 2000 and 2021. They consisted of eleven RCTs (14,15,24,(16)(17)(18)(19)(20)(21)(22)(23), four cluster randomised control trials (25)(26)(27)(28), nineteen seventeen cohort studies (29,30,(39)(40)(41)(42)(43)(44)(45)(46)(47)(31)(32)(33)(34)(35)(36)(37)(38), one records reviews (48) and one quasi trial (49). All thirty-six had a control group and provided estimates of effect: Eleven evaluated community health care worker direct observation therapy (CHWDOT) (24,27,31,38) (14,19,25,26,29,33,39), nine evaluated family direct observat...…”

“…The results of these studies showed a treatment success ratio ranged from 1.0-4.33 and the 95% CI fell within 0.98-95.4 values all with no statistical significant effect on treatment success. (30,42,45,46) Suggesting that electronic medication monitor is effective on treatment outcomes especially in the countries with lower economies.…”

Effect of mobile health reminders on tuberculosis treatment outcomes in Shanghai, China: A prospective cohort study

“…WHO recently encouraged using digital health technologies such as short message service (SMS), video-supported treatment (VOT), and medication event monitoring systems (MEMS) to help TB patients complete treatment ( 2 , 9 ). In China, an electronic medication monitor (EMM) without real-time data transmission has been used in 138 counties in three provinces ( 10 ). A cluster-randomized trial proved that the EMM improved medication adherence in TB patients while SMS did not ( 11 ).…”

“…A cluster-randomized trial proved that the EMM improved medication adherence in TB patients while SMS did not ( 11 ). But the effect of the EMM and SMS on TB treatment outcomes remains controversial ( 10 , 12–15 ). Additionally, the EMM cannot provide real-time medication adherence data which may impede timely intervention from healthcare providers.…”