mHealth for Tuberculosis Treatment Adherence: A Framework to Guide Ethical Planning, Implementation, and Evaluation

Abstract

Promising mHealth approaches for TB treatment adherence include:Video observationPatient- or device-facilitated indirect monitoringDirect monitoring through embedded sensors or metabolite testingTo mitigate ethical concerns, our framework considers accuracy of monitoring technologies, stigmatization and intrusiveness of the technologies, use of incentives, and the balance of individual and public good.

A Multistakeholder-Centric Data Analytics Governance Framework for Medication Adherence and Improvement in Rural Settings

“…Indirect monitoring entails the use of technology devices for tracking activities that could signal when a patient has taken the drug or not. Many indirect adherence monitoring methods are device-facilitated by using various technologies [3,4]. Device-facilitated measuring can be classified into various categories such as sensor-based systems, proximity-based systems, vision-based systems, and fusion-based systems [4].…”

“…The use of smart pill containers entails the detection of cap opening and bottle pick up to track adherence. Examples of these type of initiatives include Wisepills [5], Memscap [6], GlowCap [3,7], Evrimed [8], and Amiko [9]. Wearable sensors detect motions related to cap twisting, hand-to-mouth, pouring the pill into the hand, and pill swallowing.…”

“…Also, ingestible biosensors have been used to detect pill ingestion by patients to track medication adherence [15,16]. Currently, the use of ingestible biosensors has proved to be the most accurate, however, many patients will not find it convenient to ingest a biosensor so that they can be tracked to determine if they have taken their medication or not [3,15,17]. Proximity-based systems are non-invasive systems that detect medication presence or absence within the proximity of a reader's antenna by using computer vision technology.…”

“…An optimal level of positive adherence behaviour is difficult to attain in low resource settings and rural areas due to many socio-economic problems. So far, several adherence-monitoring technologies such as Direct Observation Therapy (DOT), Video Observation Therapy (VOT), Indirect Monitoring Technology (Patient-facilitated or Device-facilitated), and Direct Monitoring Technology are being used to monitor adherence [2,3]. However, these methods have not yielded maximum improvement in treatment outcomes because of the challenges of medication adherence particularly associated with older people, and persons in rural settings [4].…”

“…The socio-economic challenges of people in the rural setting ranging from poverty, illiteracy, poor infrastructure, shortage of good medical facilities, and medical experts make it difficult for healthcare organisations to effectively monitor medication adherence of patients in these settings and to motivate them for good adherence behaviour. Generally, existing methods have failed to embrace a multiple stakeholder approach that can encourage the patient towards positive adherence during the treatment journey [3]. There is also a lack of consideration for the dynamics of the everyday life of a patient, which could affect adherence behaviour.…”