Putting technology to the test in tuberculosis care

Inadequate adherence to treatment for tuberculosis disease is associated with increased rates of unfavourable outcomes, including death, disease recurrence, and development of drug resistance. 1 Imperial MZ Nahid P Phillips PPJ et al. A patient-level pooled analysis of treatment-shortening regimens for drug-susceptible pulmonary tuberculosis. Nat Med. 2018; 24: 1708-1715 Crossref PubMed Scopus (189) Google Scholar , 2 Thomas A Gopi PG Santha T et al. Predictors of relapse among pulmonary tuberculosis patients treated in a DOTS programme in South India. Int J Tuberc Lung Dis. 2005; 9: 556-561 PubMed Google Scholar , 3 Subbaraman R Thomas BE Kumar JV et al. Understanding nonadherence to tuberculosis medications in India using urine drug metabolite testing: a cohort study. Open Forum Infect Dis. 2021; 8: ofab190 Crossref PubMed Scopus (16) Google Scholar , 4 Bradford WZ Martin JN Reingold AL Schecter GF Hopewell PC Small PM The changing epidemiology of acquired drug-resistant tuberculosis in San Francisco, USA. Lancet. 1996; 348: 928-931 Summary Full Text Full Text PDF PubMed Scopus (98) Google Scholar Given the importance of improving adherence, along with shifts away from monitoring with in-person directly observed therapy as part of tuberculosis programmes, there has been increasing use of digital adherence technologies (DATs) in tuberculosis care over the past decade. DATs leverage the global expansion of cellular networks to enable dosing reminders, remote digital observation of pill-taking, and other services for people with tuberculosis. These technologies include video observed therapy, which is used more commonly in high-income countries, as well as two-way SMS-based, mobile phone-based, and digital pillbox-based strategies, used more commonly in low-income and middle-income countries (LMICs). Effectiveness of a comprehensive package based on electronic medication monitors at improving treatment outcomes among tuberculosis patients in Tibet: a multicentre randomised controlled trialThe interventions were effective at improving tuberculosis treatment adherence and outcomes, and the trial suggests that a comprehensive package involving electronic medication monitors might positively affect tuberculosis programmes in high-burden and low-resource settings. Full-Text PDF