Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD): Toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra

Saha, Somen; Saxena, Deepak; Raval, Devang; Halkarni, Nishad; Doshi, Rahul; Joshi, Madhav; Sridharan, Mridhula; Sathwara, Jignasa; Yasobant, Sandul; Quazi, Zahiruddin Syed; Rajsekar, Kavitha; Chowdhury, Jayeeta

doi:10.3389/fpubh.2022.1021427

Cited by 8 publications

(8 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The current landscape is still an evolving one, and evolving iterations of these devices and solutions are being piloted for understanding their use cases. Recent evaluations of the Medical Event Reminder Monitor (MERM) box [37] and TMEAD [38], both applications of EMM, has found favourable outcomes among patients using these solutions, albeit stating challenges with respect to the actual usability [37]- [41].…”

Section: Discussionmentioning

confidence: 99%

Impact of a pilot mHealth intervention on treatment outcomes of TB patients seeking care in the private sector using Propensity Scores Matching – Evidence collated from New Delhi, India

Sodhi,

Vatsyayan,

Panibatla

et al. 2023

Preprint

View full text Add to dashboard Cite

Mobile health applications called Digital Adherence Technologies (DATs) are increasingly used for improving treatment adherence among Tuberculosis patients to attain cure, and/or other chronic diseases requiring long term and complex medication regimens. These DATs are found to be useful in resource limited settings because of their cost efficiency in reaching out to vulnerable groups (providing pill & clinic visit reminders, health information and awareness on the disease along with motivational messages and support to be retained in care) or those staying in remote or rural areas. Despite their growing ubiquity, there is very limited evidence on how they improve healthcare outcomes. We analyze the uptake of such an intervention in an urban setting (DS-DOST, powered by Connect for LifeTM, Johnson & Johnson) among different patient groups accessing TB services in New Delhi, India, and subsequently assess its impact in improving patient engagement and treatment outcomes. This study aims to understand the uptake patterns of a digital adherence technology and its impact in improving follow ups and treatment outcomes among TB patients. Propensity choice modelling was used to create balanced treated and untreated patient datasets, before applying simple ordinary least square and logistic regression methods to estimate the causal impact of the intervention on the number of follow ups made with the patient and treatment outcomes.After controlling for potential confounders, it is found that patients who installed and utilized DS-DOST application received an average of 6.4 (95% C.I. [5.32 to 7.557]) additional follow-ups, relative to those who did not utilize the application. This translates to a 58% increase. They also had 245% higher likelihood of a treatment success (Odds ratio: 3.458; 95% C.I. [1.709 to 6.996]). Descriptive results indicate that young females, and those suffering from pulmonary tuberculosis have a slightly higher propensity to use the CfL™ app, and benefit through their treatment duration.Author SummaryThe research tries to understand the impact of using cost-effective digital adherence tools, in improving treatment outcomes among patients diagnosed with drug-sensitive Tuberculosis (TB). As the treatment duration for TB is fairly long (at least 6 months) and complicated (multiple drugs, typically given in two distinct phases), there are challenges associated with ensuring treatment adherence. The research finds that digital tools such as a mobile application – can be a useful aid, albeit only when they are used in conjunction with the support of a healthcare worker. The digital tool analyzed, while sending medication reminders to patients, also enabled healthcare workers in tracking adherence for their assigned patients. The latter, as the research finds, ensured that they follow up with their patients to ensure adherence, resulting in increased odds of their getting a favourable treatment outcome. Further, the study underscores that a digital intervention used in isolation might not draw a favourable impact among patients – highlighting the role of healthcare workers and tailored interventions. In conclusion, digital adherence technologies can act as cost-effective measures in empowering healthcare workers to support their patients, and subsequently improve treatment outcomes.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of a pilot mHealth intervention on treatment outcomes of TB patients seeking care in the private sector using Propensity Scores Matching – Evidence collated from New Delhi, India

Sodhi,

Vatsyayan,

Panibatla

et al. 2023

Preprint

View full text Add to dashboard Cite

show abstract

“…Health related quality of life. Four studies (one SMS, one VOT, and two digital pillbox studies) assessed health related quality of life (HRQOL) in persons with TB disease [16,19,34,41] using DATs, while one SMS study evaluated HRQOL in persons with TB infection [26]. All five studies used versions of the EuroQol questionnaires and found no differences between participants in the DAT and standard care groups.…”

Section: Table)mentioning

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

View full text Add to dashboard Cite

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.

show abstract

“…In a probabilistic sensitivity analysis, another study found that an AI-based VOT application [40] was dominant in 93.5% of simulations, i.e., cheaper with better health outcomes, compared to provider (clinic and field) DOT. In India, digital pillboxes were judged to be highly cost-effective compared to DOT [39].…”

Section: Cost-effectivenessmentioning

confidence: 99%

Cost and Cost-Effectiveness of Digital Technologies for Support of Tuberculosis Treatment Adherence: A Systematic Review

Kafie,

Mohamed,

Zary

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: Digital adherence technologies (DATs) may provide a patient-centered approach for supporting tuberculosis (TB) medication adherence and improving treatment outcomes. We synthesized evidence addressing costs and cost-effectiveness of DATs to support TB treatment.Methods: A systematic review (PROSPERO-CRD42022313531) identified relevant literature from January 2000-April 2023 in MEDLINE, Embase, CENTRAL, CINAHL, Web of Science along with preprints from medRxiv, Europe PMC and clinicaltrials.gov. Studies with observational, experimental, or quasi-experimental designs (minimum 20 participants) and modelling studies reporting quantitative data on the cost or cost-effectiveness of DATs for TB infection or disease treatment were included. Study characteristics, cost and cost-effectiveness outcomes were extracted.Results: Of 3,619 titles identified by our systematic search, 29 studies met inclusion criteria, of which 9 addressed cost-effectiveness. DATs included SMS reminders, phone-based technologies, digital pillboxes, ingestible sensors, and video observed treatment (VOT). VOT was the most extensively studied (16 studies) and was generally cost saving when compared to healthcare provider directly observed therapy (DOT), particularly when costs to patients were included--though findings were largely from high-income countries. Cost-effectiveness findings were highly variable, ranging from no clinical effect in one study (SMS), to greater effectiveness with concurrent cost savings (VOT) in others. Only 8 studies adequately reported at least 80% of the elements required by CHEERS, a standard reporting checklist for health economic evaluations.Conclusion: DATs may be cost-saving or cost-effective compared to healthcare provider DOT, particularly in high-income settings. However, more data of higher quality are needed, notably in lower- and middle-income countries which have the greatest TB burden.

show abstract

Tuberculosis Monitoring Encouragement Adherence Drive (TMEAD): Toward improving the adherence of the patients with drug-sensitive tuberculosis in Nashik, Maharashtra

Cited by 8 publications

References 20 publications

Impact of a pilot mHealth intervention on treatment outcomes of TB patients seeking care in the private sector using Propensity Scores Matching – Evidence collated from New Delhi, India

Impact of a pilot mHealth intervention on treatment outcomes of TB patients seeking care in the private sector using Propensity Scores Matching – Evidence collated from New Delhi, India

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

Cost and Cost-Effectiveness of Digital Technologies for Support of Tuberculosis Treatment Adherence: A Systematic Review

Contact Info

Product

Resources

About