Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine

Scott, AuthorsNigel A; Sadowski, Claire; Vernon, Andrew; Arevalo, Bert; Beer, Karlyn D.; Борисов, А. A.; Caylà, Joan A.; Chen, Michael; Feng, Pei-Jean; Moro, Ruth N.; Holland, David; Martinson, Neil; Millet, Joan-Pau; Miró, José M.; Belknap, Robert

doi:10.1016/j.cct.2023.107173

Cited by 3 publications

(4 citation statements)

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“… 35 36 One assessed performance in an inpatient cohort 37 while one focused on TB infection. 33 Four reports included pill counts conducted at clinic visits as at least one of their reference standards 3335 37 while one used unannounced urine colour testing for rifampin at home visits 34 ( table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…34 In one article, when compared against pill count among persons treated for TB infection, digital pillboxes were very sensitive for adherence (93% (95% CI 90% to 95%)) and specific for non-adherence (100% (95% CI 97% to 100%)) and generally remained so in subgroup analyses involving various study sites ( table 3 ). 33 …”

Section: Resultsmentioning

confidence: 99%

“…While a few studies suggested stronger performance of digital pillboxes, this was potentially biased by inpatient treatment 37 or shorter course drug regimens. 33 …”

Section: Discussionmentioning

confidence: 99%

“…We did not identify any reports evaluating the performance of doses observed by video against urine tests or pill counts, although video-supported treatment has been used increasingly in high-income countries. 49 51 Most reports focused on outpatients with drug-susceptible TB disease, except one that involved persons with TB infection, 33 and one that involved an inpatient cohort of persons with HIV and multidrug-resistant TB disease. 37 Our ability to draw specific conclusions for the latter two groups is therefore limited.…”

Section: Discussionmentioning

confidence: 99%

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The performance of digital technologies for measuring tuberculosis medication adherence: a systematic review

Zary,

Mohamed,

Kafie

et al. 2024

BMJ Glob Health

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IntroductionDigital adherence technologies (DATs), such as phone-based technologies and digital pillboxes, can provide more person-centric approaches to support tuberculosis (TB) treatment. However, there are varying estimates of their performance for measuring medication adherence.MethodsWe conducted a systematic review (PROSPERO—CRD42022313526), which identified relevant published literature and preprints from January 2000 to April 2023 in five databases. Studies reporting quantitative data on the performance of DATs for measuring TB medication adherence against a reference standard, with at least 20 participants, were included. Study characteristics and performance outcomes (eg, sensitivity, specificity and predictive values) were extracted. Sensitivity was the proportion correctly classified as adherent by the DAT, among persons deemed adherent by a reference standard. Specificity was the proportion correctly classified as non-adherent by the DAT, among those deemed non-adherent by a reference standard.ResultsOf 5692 studies identified by our systematic search, 13 met inclusion criteria. These studies investigated medication sleeves with phone calls (branded as ‘99DOTS’; N=4), digital pillboxes N=5), ingestible sensors (N=2), artificial intelligence-based video-observed therapy (N=1) and multifunctional mobile applications (N=1). All but one involved persons with TB disease. For medication sleeves with phone calls, compared with urine testing, reported sensitivity and specificity were 70%–94% and 0%–61%, respectively. For digital pillboxes, compared with pill counts, reported sensitivity and specificity were 25%–99% and 69%–100%, respectively. For ingestible sensors, the sensitivity of dose detection was ≥95% compared with direct observation. Participant selection was the most frequent potential source of bias.ConclusionThe limited number of studies available suggests suboptimal and variable performance of DATs for dose monitoring, with significant evidence gaps, notably in real-world programmatic settings. Future research should aim to improve understanding of the relationships of specific technologies, settings and user engagement with DAT performance and should measure and report performance in a more standardised manner.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…While a few studies suggested stronger performance of digital pillboxes, this was potentially biased by inpatient treatment 37 or shorter course drug regimens. 33 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The performance of digital technologies for measuring tuberculosis medication adherence: a systematic review

Zary,

Mohamed,

Kafie

et al. 2024

BMJ Glob Health

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Screening for latent tuberculosis in migrants—status quo and future challenges

Petersen,

Al-Abri,

Al-Jardani

et al. 2024

International Journal of Infectious Diseases

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The Performance of Digital Technologies for Measuring Tuberculosis Medication Adherence: A Systematic Review

Zary,

Mohamed,

Kafie

et al. 2024

Preprint

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IntroductionDigital adherence technologies (DATs), such as phone-based technologies, and digital pillboxes, can provide more person-centric approaches to support tuberculosis (TB) medication adherence. We synthesized evidence addressing the performance of DATs for measuring tuberculosis medication adherence.MethodsWe conducted a systematic review (PROSPERO - CRD42022313526) which identified relevant published literature from January 2000 through April 2023 in five databases, and pertinent preprints. Studies reporting quantitative data on the performance of DATs for measuring adherence to medications for TB disease or infection, against a reference standard, with at least 20 participants using the DAT were included. Study characteristics and performance outcomes (e.g., sensitivity, specificity, positive and negative predictive values) were extracted. Article quality was assessed using the QUADAS-2 tool for diagnostic accuracy studies.ResultsOf 5692 studies initially identified by our systematic search, 13 met our inclusion criteria. These studies addressed the performance of medication sleeves with phone calls [branded as “99DDOTS”; N=4], digital pillboxes [N=5], ingestible sensors [N=2], artificial intelligence-based video observed therapy [N=1], and multifunctional mobile applications [N=1]. All but one involved persons with TB disease. For medication sleeves with phone calls, compared to urine analysis, reported sensitivity and specificity was 70-94% and 0-61%, respectively. For digital pillboxes, compared to pill count, reported sensitivity and specificity was 25-99% and 69-100%, respectively. For ingestible sensors, the sensitivity of dose detection was ≥95% in comparison to directly observed ingestion. Participant selection was the most frequent potential source of bias across articles.ConclusionLimited available data suggest suboptimal and variable performance of DATs for dose monitoring, with significant evidence gaps, notably in real-world programmatic settings. Future research should aim to improve understanding of the relationships of specific technologies, settings, user characteristics, and user engagement with DAT performance, and should measure and report performance in a more standardized manner.KEY MESSAGESWhat is already known on this topicSeveral cohort studies have suggested that digital adherence technologies (DATs) can both underestimate and overestimate medication ingestion among persons treated for tuberculosis. No previous review has synthesized available evidence in this regard.What this study addsReports of DAT (medication sleeves with phone calls, digital pillboxes) implementation in real-world treatment settings consistently indicate suboptimal performance for measuring medication adherence. However, available evidence is limited in scope and quality.How this study might affect research, practice, or policySuboptimal dose reporting from DATs potentially compromises their effectiveness, and program efficiency. Future clinical practice will be strengthened by rigorous technology evaluations that reflect more consistent use of reference standards, and clearer benchmarks for medication adherence.

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Using a medication event monitoring system to evaluate self-report and pill count for determining treatment completion with self-administered, once-weekly isoniazid and rifapentine

Cited by 3 publications

References 14 publications

The performance of digital technologies for measuring tuberculosis medication adherence: a systematic review

The performance of digital technologies for measuring tuberculosis medication adherence: a systematic review

Screening for latent tuberculosis in migrants—status quo and future challenges

The Performance of Digital Technologies for Measuring Tuberculosis Medication Adherence: A Systematic Review

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