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Zary M, Mohamed MS, Kafie C, Chilala CI, Bahukudumbi S, Foster N, Gore G, Fielding KL, Subbaraman R, Schwartzman K. The performance of digital technologies for measuring tuberculosis medication adherence: a systematic review. BMJ Glob Health 2024; 9:e015633. [PMID: 39013639 PMCID: PMC11288144 DOI: 10.1136/bmjgh-2024-015633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
INTRODUCTION Digital 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. METHODS We 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. RESULTS Of 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. CONCLUSION The 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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Affiliation(s)
- Miranda Zary
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mona Salaheldin Mohamed
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Cedric Kafie
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Shruti Bahukudumbi
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Nicola Foster
- TB Centre, London School of Hygiene and Tropical Medicine, London, UK
| | - Genevieve Gore
- McGill Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, Quebec, Canada
| | | | - Ramnath Subbaraman
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Kevin Schwartzman
- McGill International Tuberculosis Centre, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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Chen EC, Owaisi R, Goldschmidt L, Maimets IK, Daftary A. Patient perceptions of video directly observed therapy for tuberculosis: a systematic review. J Clin Tuberc Other Mycobact Dis 2024; 35:100406. [PMID: 38380432 PMCID: PMC10877938 DOI: 10.1016/j.jctube.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Virtual modes of tuberculosis (TB) treatment monitoring have become increasingly relevant in the last decade with the advancements and increasing accessibility of technology. We conducted a systematic review comparing people with TB's perceptions of standard directly observed therapy (DOT) versus video directly observed therapy (vDOT). Studies were obtained from MEDLINE and EMBASE between January 1, 1974 and February 4, 2021. Of the 22 articles reviewed, a qualitative thematic analysis was performed, drawing on common themes from people with TB's perception of their care. 21 studies showed relative preference for and acceptance of vDOT over DOT. Factors that increased acceptability toward vDOT included cost and time saving, personal sense of empowerment, convenience, and privacy. Studies also showed greater adherence to treatment and subsequent improved health outcomes. vDOT has the potential to be an empowering, person-centered treatment modality for TB therapy. The role of social determinants such as place of residence, access to technology, and patient-provider communication requires further exploration.
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Affiliation(s)
- En Chi Chen
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
| | - Rumia Owaisi
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- School of Global Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Leah Goldschmidt
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- School of Global Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
| | - Ilo-Katryn Maimets
- Steacie Science and Engineering Library, York University, 136 Campus Walk, North York, ON M3J 1P3, Canada
| | - Amrita Daftary
- Dahdaleh Institute of Global Health Research, York University, 88 The Pond Rd Suite 2150, North York, ON M3J 2S5, Canada
- School of Global Health, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban 4001, South Africa
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Garfein RS, Liu L, Cepeda J, Graves S, San Miguel S, Antonio A, Cuevas-Mota J, Mercer V, Miller M, Catanzaro DG, Rios P, Raab F, Benson CA. Asynchronous Video Directly Observed Therapy to Monitor Short-Course Latent Tuberculosis Infection Treatment: Results of a Randomized Controlled Trial. Open Forum Infect Dis 2024; 11:ofae180. [PMID: 38665171 PMCID: PMC11045025 DOI: 10.1093/ofid/ofae180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
Background Observing medication ingestion through self-recorded videos (video directly observed therapy [VDOT]) has been shown to be a cost-effective alternative to in-person directly observed therapy (DOT) for monitoring adherence to treatment for tuberculosis disease. VDOT could be a useful tool to monitor short-course latent tuberculosis infection (LTBI) treatment. Methods We conducted a prospective randomized controlled trial comparing VDOT (intervention) and clinic-based DOT (control) among patients newly diagnosed with LTBI who agreed to a once-weekly 3-month treatment regimen of isoniazid and rifapentine. Study outcomes were treatment completion and patient satisfaction. We also assessed costs. Pre- and posttreatment interviews were conducted. Results Between March 2016 and December 2019, 130 participants were assigned to VDOT (n = 68) or DOT (n = 62). Treatment completion (73.5% vs 69.4%, P = .70) and satisfaction with treatment monitoring (92.1% vs 86.7%, P = .39) were slightly higher in the intervention group than the control group, but neither was statistically significant. VDOT cost less per patient (median, $230; range, $182-$393) vs DOT (median, $312; range, $246-$592) if participants used their own smartphone. Conclusions While both groups reported high treatment satisfaction, VDOT was not associated with higher LTBI treatment completion. However, VDOT cost less than DOT. Volunteer bias might have reduced the observed effect since patients opposed to any treatment monitoring could have opted for alternative unobserved regimens. Given similar outcomes and lower cost, VDOT may be useful for treatment monitoring when in-person observation is prohibited or unavailable (eg, during a respiratory disease outbreak). The trial was registered at the National Institutes of Health (ClinicalTrials.gov NTC02641106). Clinical Trials Registration ClinicalTrials.gov NTC02641106; registered 24 October 2016.
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Affiliation(s)
- Richard S Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego, California, USA
| | - Lin Liu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susannah Graves
- Tuberculosis Control and Refugee Health Branch, San Diego County Health and Human Services Agency, San Diego, California, USA
| | - Stacie San Miguel
- Student Health Services, University of California, San Diego, California, USA
| | - Antonette Antonio
- Tuberculosis Control and Refugee Health Branch, San Diego County Health and Human Services Agency, San Diego, California, USA
| | - Jazmine Cuevas-Mota
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - Valerie Mercer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, California, USA
| | - McKayla Miller
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego, California, USA
| | - Donald G Catanzaro
- Department of Biological Sciences, University of Arkansas, Fayetteville, Arkansas, USA
| | - Phillip Rios
- Qualcomm Institute, Calit2, San Diego Division, University of California, San Diego, California, USA
| | - Fredric Raab
- Qualcomm Institute, Calit2, San Diego Division, University of California, San Diego, California, USA
| | - Constance A Benson
- Division of Infectious Disease and Global Public Health, School of Medicine, University of California, San Diego, California, USA
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Abas SA, Ismail N, Zakaria Y, Yasin SM, Ibrahim K, Ismail I, Razali A, Sherzkawi MA, Ahmad N. Enhancing tuberculosis treatment adherence and motivation through gamified real-time mobile app utilization: a single-arm intervention study. BMC Public Health 2024; 24:249. [PMID: 38254065 PMCID: PMC10801941 DOI: 10.1186/s12889-023-17561-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Finding innovative methods to enhance Tuberculosis treatment adherence in Malaysia is imperative, given the rising trend of non-adhere TB patients. Direct Observed Therapy (DOTS) has been used to ensure Tuberculosis (TB) drug compliance worldwide. However, due to its inconvenience, digitalizing this system into a virtual monitoring system via a mobile app can help deliver a more efficient tuberculosis management system. A gamified video-observed therapy is developed that connects three users the patient, supervisor, and administrator, allowing drug monitoring and patient loss to follow up with the patient tracking system. Thus, the objective of this study is to determine the impact of Gamified Real-time Video Observed Therapy (GRVOTS) mobile apps on patient medication adherence rates and motivation. METHODS 71 patients from 18 facilities participated in the 8-week single-arm intervention study. GRVOTS mobile apps were installed in their mobile apps, and patients were expected to fulfill tasks such as providing Video Direct Observe Therapy (VDOTS) daily as well as side effect reporting. At 3-time intervals of baseline,1-month, and 2-month intervals, the number of VDOT taken, the Malaysian Medication Adherence Assessment Tool (MyMAAT), and the Intrinsic Motivation Inventory (IMI) questionnaire were collected. One-sample t-test was conducted comparing the VDOT video adherence to the standard rate of 80%. RM ANOVA was used to analyze any significant differences in MyMAAT and IMI scores across three-time intervals. RESULTS This study involved 71 numbers of patients from 18 healthcare facilities who showed a significantly higher treatment adherence score of 90.87% than a standard score of 80% with a mean difference of 10.87(95% CI: 7.29,14.46; p < 0.001). The participants' MyMAAT and IMI scores significantly increased over 3-time intervals with the IMI Interest domain showing the highest mean difference 19.76 (95% CI: 16.37, 21.152: p < 0.001). CONCLUSIONS By utilizing GRVOTS, a mobile application based on gamification and real-time features, we can enhance motivation and medication adherence among TB patients, while also addressing the limitations of physical DOTS. TRIAL REGISTRATION IRCT20230308057657N1, Registered on (15/03/23).
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Affiliation(s)
- Siti Aishah Abas
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia
| | - Nurhuda Ismail
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia.
| | - Yuslina Zakaria
- Department of Pharmaceutical Life Sciences, Faculty of Pharmacy, Universiti Teknologi MARA Puncak Alam Campus, Puncak Alam, Selangor, 42300, Malaysia
| | - Siti Munira Yasin
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia
| | - Khalid Ibrahim
- Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, Selangor, 47000, Malaysia
| | - Ismassabah Ismail
- Centre of Foundation Studies, Universiti Teknologi MARA Cawangan Selangor, Kampus Dengkil, Dengkil, Selangor, 43800, Malaysia
| | - Asmah Razali
- Disease Control Division, Sector TB/Leprosy, Ministry of Health, Putrajaya, 62590, Malaysia
| | - Mas Ahmad Sherzkawi
- TB/Leprosy Disease Unit, Selangor State Health Department, Seksyen 9, Shah Alam, Selangor, 40100, Malaysia
| | - Norliza Ahmad
- TB/Leprosy Disease Unit, Negeri Sembilan State Health Department, Jalan Rasah, Bukit Rasah, Negeri Sembilan, Seremban, 70300, Malaysia
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Danielli S, Ashrafian H, Darzi A. Healthy city: global systematic scoping review of city initiatives to improve health with policy recommendations. BMC Public Health 2023; 23:1277. [PMID: 37393224 PMCID: PMC10314468 DOI: 10.1186/s12889-023-15908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/12/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Global health will increasingly be determined by cities. Currently over half of the world's population, over 4 billion people, live in cities. This systematic scoping review has been conducted to understand what cities are doing to improve health and healthcare for their populations. METHODS We conducted a systematic search to identify literature on city-wide initiatives to improve health. The study was conducted in accordance with PRISMA and the protocol was registered with PROSPERO (CRD42020166210). RESULTS The search identified 42,137 original citations, yielding 1,614 papers across 227 cities meeting the inclusion criteria. The results show that the majority of initiatives were targeted at non-communicable diseases. City health departments are making an increasing contribution; however the role of mayors appears to be limited. CONCLUSION The collective body of evidence identified in this review, built up over the last 130 years, has hitherto been poorly documented and characterised. Cities are a meta-system with population health dictated by multiple interactions and multidirectional feedback loops. Improving health in cities requires multiple actions, by multiple actors, at every level. The authors use the term 'The Vital 5'. They are the five most important health risk factors; tobacco use; harmful alcohol use; physical-inactivity, unhealthy diet and planetary health. These 'Vital 5' are most concentrated in deprived areas and show the greatest increase in low and middle income countries. Every city should develop a comprehensive strategy and action plan to address these 'Vital 5'.
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Affiliation(s)
- Shaun Danielli
- Kings Health Partners, Guys Hospital, London, SE1 9RT, UK.
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK.
| | - Hutan Ashrafian
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK
| | - Ara Darzi
- Imperial College London, South Kensington Campus, London, SW7 2NA, UK
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Margineanu I, Louka C, Akkerman O, Stienstra Y, Alffenaar JW. eHealth in TB clinical management. Int J Tuberc Lung Dis 2022; 26:1151-1161. [PMID: 36447317 PMCID: PMC9728950 DOI: 10.5588/ijtld.21.0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND: The constant expansion of internet and mobile technologies has created new opportunities in the field of eHealth, or the digital delivery of healthcare services. This TB meta-analysis aims to examine eHealth and its impact on TB clinical management in order to formulate recommendations for further development.METHODS: A systematic search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework in PubMed and Embase of articles published up to April 2021. Screening, extraction and quality assessment were performed by two independent researchers. Studies evaluating an internet and/or mobile-based eHealth intervention with an impact on TB clinical management were included. Outcomes were organised following the five domains described in the WHO "Recommendations on Digital Interventions for Health System Strengthening" guideline.RESULTS: Search strategy yielded 3,873 studies, and 89 full texts were finally included. eHealth tended to enhance screening, diagnosis and treatment indicators, while being cost-effective and acceptable to users. The main challenges concern hardware malfunction and software misuse.CONCLUSION: This study offers a broad overview of the innovative field of eHealth applications in TB. Different studies implementing eHealth solutions consistently reported on benefits, but also on specific challenges. eHealth is a promising field of research and could enhance clinical management of TB.
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Affiliation(s)
- I Margineanu
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, the Netherlands, Iasi Pulmonary Diseases University Hospital, Iasi, Romania
| | - C Louka
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - O Akkerman
- Tuberculosis Center Beatrixoord, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Department of Pulmonary Diseases and Tuberculosis, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Y Stienstra
- Department of Internal Medicine/Infectious Diseases, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J-W Alffenaar
- Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Groningen, the Netherlands, Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Camperdown, NSW, Australia, Westmead Hospital, Sydney, NSW, Australia, Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia
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Rangaka MX, Hamada Y, Duong T, Bern H, Calvert J, Francis M, Clarke AL, Ghanouni A, Layton C, Hack V, Owen-Powell E, Surey J, Sanders K, Booth HL, Crook A, Griffiths C, Horne R, Kunst H, Lipman M, Mandelbaum M, White PJ, Zenner D, Abubakar I. Evaluating the effect of short-course rifapentine-based regimens with or without enhanced behaviour-targeted treatment support on adherence and completion of treatment for latent tuberculosis infection among adults in the UK (RID-TB: Treat): protocol for an open-label, multicentre, randomised controlled trial. BMJ Open 2022; 12:e057717. [PMID: 36691120 PMCID: PMC9454004 DOI: 10.1136/bmjopen-2021-057717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 01/24/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The successful scale-up of a latent tuberculosis (TB) infection testing and treatment programme is essential to achieve TB elimination. However, poor adherence compromises its therapeutic effectiveness. Novel rifapentine-based regimens and treatment support based on behavioural science theory may improve treatment adherence and completion. METHODS AND ANALYSIS A pragmatic multicentre, open-label, randomised controlled trial assessing the effect of novel short-course rifapentine-based regimens for TB prevention and additional theory-based treatment support on treatment adherence against standard-of-care. Participants aged between 16 and 65 who are eligible to start TB preventive therapy will be recruited in England. 920 participants will be randomised to one of six arms with allocation ratio of 5:5:6:6:6:6: daily isoniazid +rifampicin for 3 months (3HR), routine treatment support (control); 3HR, additional treatment support; weekly isoniazid +rifapentine for 3 months (3HP), routine treatment support; weekly 3HP, additional treatment support ; daily isoniazid +rifapentine for 1 month (1HP), routine treatment support; daily 1HP, additional treatment support. Additional treatment support comprises reminders using an electronic pillbox, a short animation, and leaflets based on the perceptions and practicalities approach. The primary outcome is adequate treatment adherence, defined as taking ≥90% of allocated doses within the pre-specified treatment period, measured by electronic pillboxes. Secondary outcomes include safety and TB incidence within 12 months. We will conduct process evaluation of the trial interventions and assess intervention acceptability and fidelity and mechanisms for effect and estimate the cost-effectiveness of novel regimens. The protocol was developed with patient and public involvement, which will continue throughout the trial. ETHICS AND DISSEMINATION Ethics approval has been obtained from The National Health Service Health Research Authority (20/LO/1097). All participants will be required to provide written informed consent. We will share the results in peer-reviewed journals. TRIAL REGISTRATION NUMBER EudraCT 2020-004444-29.
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Affiliation(s)
- Molebogeng X Rangaka
- Institute for Global Health, University College London, London, UK
- School of Public Health, and Clinical Infectious Disease Research Institute-AFRICA, University of Cape Town, Cape Town, South Africa
| | - Yohhei Hamada
- Institute for Global Health, University College London, London, UK
| | - Trinh Duong
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Henry Bern
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Joanna Calvert
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Marie Francis
- Institute for Global Health, University College London, London, UK
| | | | - Alex Ghanouni
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Charlotte Layton
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Vanessa Hack
- Institute for Global Health, University College London, London, UK
| | - Ellen Owen-Powell
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Julian Surey
- Institute for Global Health, University College London, London, UK
| | - Karen Sanders
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Helen L Booth
- North Central London Tuberculosis Service, Whittington Health NHS Trust and University College London Hospitals NHS Foundation Trust, London, UK
| | - Angela Crook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Chris Griffiths
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Robert Horne
- Centre for Behavioural Medicine, UCL School of Pharmacy, London, UK
| | - Heinke Kunst
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Marc Lipman
- UCL Respiratory, Division of Medicine, University College, London, UK
- Royal Free London Hospital NHS Foundation Trust, London, UK
| | | | - Peter J White
- Modelling and Economics Unit, National Infection Service, Public Health England, London, UK
- MRC Centre for Global Infectious Disease Analysis, Imperial College, London, UK
| | - Dominik Zenner
- Institute for Global Health, University College London, London, UK
- Wolfson Institute for Population Health Barts and the London School of Medicine and Dentistry, Queen Mary University, London, UK
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London, UK
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Stoner MC, Maragh-Bass A, Sukhija-Cohen A, Saberi P. Digital directly observed therapy to monitor adherence to medications: a scoping review. HIV Res Clin Pract 2022; 23:47-60. [PMID: 35904111 PMCID: PMC9554236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Technology-based directly observed therapy (DOT) is more cost-effective and efficient compared with in-person monitoring visits for medication adherence. While some evidence shows these technologies are feasible and acceptable, there is limited evidence collating information across medical conditions or in the context of HIV prevention, care, and treatment.Objectives: We conducted a scoping review to understand the current evidence on the acceptability, feasibility, and efficacy of digital DOT to improve medication adherence and, specifically, to determine if digital DOT had been used to improve adherence for HIV prevention, care, and treatmentMethods: We searched the electronic databases PubMed, Embase, and the Web of Science in January 2021 for any published studies with terms related to digital technologies and DOT. We included peer-reviewed studies in any population, from any country, for any outcome, and excluded conference abstracts. We included three types of digital DOT interventions: synchronous DOT, asynchronous DOT, and automated DOT. We provide an assessment of the current evidence, gaps in literature, and opportunities for intervention development regarding the use digital DOT to improve antiretroviral therapy (ART) adherence, specifically in the field of HIV.Results: We identified 28 studies that examined digital DOT. All studies found digital DOT to be acceptable and feasible. Patients using digital DOT had higher rates of treatment completion, observed doses, and adherence compared with in-person DOT, although data were limited on adherence. Only one study examined HIV prevention, and none examined ART adherence for HIV treatment.Conclusions: Digital DOT is acceptable and feasible but has not been used to remotely monitor and support ART adherence for people living with HIV.
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Affiliation(s)
- Marie C.D. Stoner
- Women’s Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Allysha Maragh-Bass
- Behavioral, Epidemiological, and Clinical Sciences Division, HI 360, Durham, NC, USA,Duke Global Health Institute, Duke University, Durham, NC, USA
| | | | - Parya Saberi
- Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
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Creary SE, Beeman C, Stanek J, King K, McGann PT, O’Brien SH, Liem RI, Holl J, Badawy SM. Impact of hydroxyurea dose and adherence on hematologic outcomes for children with sickle cell anemia. Pediatr Blood Cancer 2022; 69:e29607. [PMID: 35373884 PMCID: PMC9038671 DOI: 10.1002/pbc.29607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 01/28/2022] [Accepted: 02/01/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hydroxyurea is the primary treatment for sickle cell anemia (SCA), yet real-world implementation in high-income settings is suboptimal. Variation in prescribed hydroxyurea dose and patient adherence in these settings can both affect actual exposure to hydroxyurea. Quantifying the contributions of hydroxyurea dose and medication adherence to the relationship between hydroxyurea exposure and hematologic parameters could inform strategies to optimize exposure and improve outcomes. PROCEDURE We evaluated the relationship between hydroxyurea exposure, defined by average prescribed dose and adherence, and hematologic parameters using data from children with SCA who were enrolled in two prospective hydroxyurea adherence studies. Hydroxyurea adherence was assessed by video directly observed therapy or electronic pill bottle and medication administration record. Average prescribed dose was abstracted from prescriptions in patients' electronic medical record. Participants with a hydroxyurea exposure >20 mg/kg/day and ≤20 mg/kg/day were included in the higher and lower exposure groups, respectively. RESULTS Forty-five participants were included in the analysis (56% male; median age 12 years [range 2-19]; 98% Black). Higher exposed participants (n = 23) were prescribed a higher dose (27.2 vs. 24.4 mg/kg/day, p = .002) and had better adherence (0.92 vs. 0.71, p ≤ .001) compared to lower exposed participants (n = 22). Higher exposure was associated with higher fetal hemoglobin (p = .04) and mean corpuscular volume (p = .02). CONCLUSIONS Higher hydroxyurea exposure is associated with improved hematologic parameters in the high-income setting and is affected by both prescribed dose and adherence. Future studies are needed to optimize both adherence and hydroxyurea prescribing and confirm that increasing exposure improves clinical outcomes in this setting.
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Affiliation(s)
- Susan E. Creary
- Center for Child Health Equity and Outcomes, Research Institute Nationwide Children’s Hospital, Columbus, OH,Division of Pediatric Hematology/Oncology/BMT, Nationwide Children’s Hospital & The Ohio State University, Columbus, OH
| | - Chase Beeman
- Center for Child Health Equity and Outcomes, Research Institute Nationwide Children’s Hospital, Columbus, OH
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children’s Hospital & The Ohio State University, Columbus, OH
| | - Kathryn King
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Patrick T. McGann
- Department of Pediatrics, The Warren Alpert Medical School of Brown University, Hasbro Children’s Hospital and Rhode Island Hospital, Providence, RI
| | - Sarah H. O’Brien
- Center for Child Health Equity and Outcomes, Research Institute Nationwide Children’s Hospital, Columbus, OH,Division of Pediatric Hematology/Oncology/BMT, Nationwide Children’s Hospital & The Ohio State University, Columbus, OH
| | - Robert I. Liem
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Jane Holl
- Department of Neurology and Center for Healthcare Delivery Science and Innovation, University of Chicago, Chicago, IL
| | - Sherif M. Badawy
- Division of Hematology, Oncology and Stem Cell Transplantation, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL,Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
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10
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Shahid NUA, Naguit N, Jakkoju R, Laeeq S, Reghefaoui T, Zahoor H, Yook JH, Rizwan M, Mohammed L. Use of Isoniazid Monotherapy in Comparison to Rifamycin-Based Regimen for the Treatment of Patients With Latent Tuberculosis: A Systematic Review. Cureus 2022; 14:e25083. [PMID: 35733481 PMCID: PMC9205649 DOI: 10.7759/cureus.25083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Tuberculosis (TB) is a common infectious disease that is present all around the world. This insidious disease needs drastic measures for its eradication. One of the actions contributing to it is the timely diagnosis and offering suitable treatment options for latent tuberculosis patients. In this review, we will discuss and compare the variety of options available for this purpose. We searched PubMed/Medline, Cochrane library, Google Scholar, and Science Direct to find articles regarding the effectiveness, safety, and completion of any of the five regimens available for latent tuberculosis infection. These options are the most classic and standard nine months of isoniazid given daily, which is now more commonly given as six months course, three months of daily isoniazid and rifampin, three months of weekly isoniazid and rifapentine, and four months of daily rifampin. We looked into free full-text studies published from 2011 to 2021 available in English language and human studies. After applying inclusion/exclusion criteria and removing duplicates and screening, 34 articles were shortlisted for quality assessment check, after which we finalized nine studies. Cochrane risk-of-bias assessment tool was used for quality check of randomized control trials, New-Castle Ottawa tool for observational studies, and assessment of multiple systematic reviews (AMSTAR) tool for systematic reviews. Efficacy was checked by tracking down the new cases of TB in the sample population that took the treatment for latent tuberculosis infection. New rifamycin-based regimens were almost equal in effectiveness to isoniazid regimens. The side effect profile is different for both regimens, but short-duration courses tend to have a higher chance of completion.
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11
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Pinnock H, Murphie P, Vogiatzis I, Poberezhets V. Telemedicine and virtual respiratory care in the era of COVID-19. ERJ Open Res 2022; 8:00111-2022. [PMID: 35891622 PMCID: PMC9131135 DOI: 10.1183/23120541.00111-2022] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022] Open
Abstract
The World Health Organization defines telemedicine as “an interaction between a health care provider and a patient when the two are separated by distance”. The COVID-19 pandemic has forced a dramatic shift to telephone and video consulting for follow up and routine ambulatory care for reasons of infection control. Short Message Service (“text”) messaging has proved a useful adjunct to remote consulting allowing transfer of photographs and documents. Maintaining non-communicable diseases care is a core component of pandemic preparedness and telemedicine has developed to enable (for example) remote monitoring of sleep apnoea, telemonitoring of chronic obstructive pulmonary disease, digital support for asthma self-management, remote delivery of pulmonary rehabilitation. There are multiple exemplars of telehealth instigated rapidly to provide care for people with COVID-19, to manage the spread of the pandemic, or to maintain safe routine diagnostic or treatment services.Despite many positive examples of equivalent functionality and safety, there remain questions about the impact of remote delivery of care on rapport and the longer-term impact on patient/professional relationships. Although telehealth has the potential to contribute to universal health coverage by providing cost-effective accessible care, there is a risk of increasing social health inequalities if the “digital divide” excludes those most in need of care. As we emerge from the pandemic, the balance of remote versus face-to-face consulting, and the specific role of digital health in different clinical and healthcare contexts will evolve. What is clear is that telemedicine in one form or another will be part of the “new norm”.
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12
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Khan A, Phares CR, Phuong HL, Trinh DTK, Phan H, Merrifield C, Le PTH, Lien QTK, Lan SN, Thoa PTK, Thu LTM, Tran T, Tran C, Platt L, Maloney SA, Nhung NV, Nahid P, Oeltmann JE. Overseas Treatment of Latent Tuberculosis Infection in US–Bound Immigrants. Emerg Infect Dis 2022; 28:582-590. [PMID: 35195518 PMCID: PMC8888219 DOI: 10.3201/eid2803.212131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Seventy percent of tuberculosis (TB) cases in the United States occur among non–US-born persons; cases usually result from reactivation of latent TB infection (LTBI) likely acquired before the person’s US arrival. We conducted a prospective study among US immigrant visa applicants undergoing the required overseas medical examination in Vietnam. Consenting applicants >15 years of age were offered an interferon-γ release assay (IGRA); those 12–14 years of age received an IGRA as part of the required examination. Eligible participants were offered LTBI treatment with 12 doses of weekly isoniazid and rifapentine. Of 5,311 immigrant visa applicants recruited, 2,438 (46%) consented to participate; 2,276 had an IGRA processed, and 484 (21%) tested positive. Among 452 participants eligible for treatment, 304 (67%) initiated treatment, and 268 (88%) completed treatment. We demonstrated that using the overseas medical examination to provide voluntary LTBI testing and treatment should be considered to advance US TB elimination efforts.
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13
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Truong CB, Tanni KA, Qian J. Video-Observed Therapy Versus Directly Observed Therapy in Patients With Tuberculosis. Am J Prev Med 2022; 62:450-458. [PMID: 34916094 DOI: 10.1016/j.amepre.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 10/13/2021] [Accepted: 10/18/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION This systematic review and meta-analysis synthesized evidence in the effects of video-observed therapy versus that of directly observed therapy on medication adherence, treatment completion, and tuberculosis resolution among patients with tuberculosis. METHODS Potential studies were identified from MEDLINE, Embase, CINAHLdirect, and Cochrane from inception to February 1, 2021. Inclusion criteria included (1) tuberculosis-infected population, (2) video-observed therapy as an intervention, (3) directly observed therapy as the comparison group, and (4) patient's medication adherence or clinical outcomes. Data were collected in 2021. Random-effects meta-analyses were conducted using Mantel-Haenszel methods with RR for dichotomous outcomes (medication adherence, treatment completion, and bacteriological resolution) and generic inverse variance methods with a weighted mean difference for continuous outcomes (proportion of doses observed). RESULTS A total of 9 studies were included in the systematic review and meta-analysis. Compared with patients receiving directly observed therapy, patients with video-observed therapy were associated with improved medication adherence (RR=2.79, 95% CI=2.26, 3.45, I2=25%), the proportion of doses observed (weighted mean difference=0.22, 95% CI=0.06, 0.39, I2=96%), and bacteriological resolution (RR=1.06, 95% CI=1.01, 1.11, I2=0%) but with similar treatment completion (RR=1.33, 95% CI=0.73, 2.43, I2=98%). DISCUSSION Implementation of video-observed therapy improved medication adherence and bacteriological resolution compared with that of directly observed therapy in tuberculosis-infected patients.
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Affiliation(s)
- Cong B Truong
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - Kaniz A Tanni
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, Alabama
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University, Auburn, Alabama.
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14
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Ridho A, Alfian SD, van Boven JFM, Levita J, Yalcin EA, Le L, Alffenaar JW, Hak E, Abdulah R, Pradipta IS. Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials. J Med Internet Res 2022; 24:e33062. [PMID: 35195534 PMCID: PMC8908199 DOI: 10.2196/33062] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/30/2021] [Accepted: 01/07/2022] [Indexed: 02/06/2023] Open
Abstract
Background Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. Objective This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. Methods A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. Results In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.47; 95% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. Conclusions It was found that DHT interventions can be a promising approach. However, the interventions exhibited variable effects regarding effect direction and the extent of improving TB medication adherence and clinical outcomes. Developing DHT interventions with personalized feedback is required to have a consistent and beneficial effect on medication adherence and outcomes among patients with TB.
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Affiliation(s)
- Abdurahman Ridho
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Doctor Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia
| | - Sofa D Alfian
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Job F M van Boven
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.,Medication Adherence Expertise Center of the Northern Netherlands, Groningen, Netherlands
| | - Jutti Levita
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Esin Aki Yalcin
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Ankara University, Ankara, Turkey
| | - Ly Le
- Vingroup Big Data Institute, Hanoi, Vietnam
| | - Jan-Willem Alffenaar
- Faculty of Medicine and Health, School of Pharmacy, University of Sydney, Sydney, Australia.,Sydney Institute for Infectious Diseases, Sydney, Australia.,Westmead Hospital, Sydney, Australia
| | - Eelko Hak
- Pharmacotherapy, Pharmacoepidemiology and Pharmacoeconomics, Research Institute of Pharmacy, University of Groningen, Groningen, Netherlands
| | - Rizky Abdulah
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
| | - Ivan S Pradipta
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Sumedang, Indonesia
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15
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Alvarez GG, Sullivan K, Pease C, Van Dyk D, Mallick R, Taljaard M, Grimshaw JM, Amaratunga K, Allen C, Brethour K, Mulpuru S, Pakhale S, Aaron SD, Cameron DW, Alsdurf H, Hui C, Zwerling AA. Effect of implementation of a 12 dose once-weekly treatment (3HP) in addition to standard regimens to prevent TB on completion rates: Interrupted time series design. Int J Infect Dis 2022; 117:222-229. [PMID: 35121126 DOI: 10.1016/j.ijid.2022.01.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/07/2022] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE We aimed to determine if offering a 12 dose once-weekly treatment (3HP) as an additional treatment option would result in an increase in the overall proportion of patients completing TB preventive treatment (TPT) above the baseline rate. METHODS We analyzed outcomes in consecutive adults referred to a TB clinic from January 2010 to May 2019. Starting December 2016, 3HP was offered as an alternative to standard clinic regimens which included 9 months of daily isoniazid or 4 months of daily rifampin. The primary outcome was the proportion who completed TPT among all patients who started treatment. Using segmented autoregression analysis we compared completion at the end of the study to projected completion had the intervention not been introduced. RESULTS A total of 2803 adults were referred for assessment over the study period. There was an absolute increase in completions among all of those who started a treatment of 19.0% at the end of the study between the observed intervention completion rate and the projected completion rate from the baseline study period (the completion rate had the 3HP intervention not been introduced) (76% observed vs 57% projected, 95% CI 6.6 to 31.4%, p = 0.004) and an absolute increase among those who were offered treatment of 17.3% 95% CI, 2.3 to 32.3%, p = 0.025). INTERPRETATION The introduction of 3HP for TPT as an alternative to the regular regimens offered resulted in a significant increase in the proportion of patients completing treatment. Our study provides evidence to support accelerated use of 3HP in Canada.
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Affiliation(s)
- Gonzalo G Alvarez
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Kathryn Sullivan
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher Pease
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Ranjeeta Mallick
- School of Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Kanchana Amaratunga
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Crystal Allen
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kaitlan Brethour
- School of Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Sunita Mulpuru
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Smita Pakhale
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Shawn D Aaron
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - D William Cameron
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Hannah Alsdurf
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada
| | - Charles Hui
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alice A Zwerling
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; McGill International Tuberculosis Centre, McGill University Health Centre, Montreal, Quebec, Canada
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16
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Wong YJ, Ng KY, Lee SWH. Digital health use in latent tuberculosis infection care: A systematic review. Int J Med Inform 2022; 159:104687. [PMID: 35007924 DOI: 10.1016/j.ijmedinf.2022.104687] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/12/2021] [Accepted: 01/02/2022] [Indexed: 11/17/2022]
Abstract
PURPOSE With one-quarter of the world's population estimated to have latent tuberculosis infection (LTBI), it is important that the drop-outs from the LTBI cascade of care are minimized. Digital health technology could play an important role in case detection and treatment adherence. This study aims to evaluate the use and impact of digital health technology in LTBI care. METHODS A systematic literature search was conducted on six electronic databases from database inception until May 31st 2021. Studies that reported on the clinical use or economic analysis of digital health technology for LTBI care were included. Two investigators independently evaluated, extracted relevant studies, and assessed the risk of bias of using the Cochrane tools. The studies were synthesized qualitatively. RESULTS Fifteen articles describing 14 studies were included. Voice and/or textual reminders and synchronous video call to improve LTBI treatment adherence were the most commonly examined digital health interventions. Other interventions examined the use of mobile phones to improve the number of patients who returned for tuberculin skin test follow-up measurement (screening retention) and eLearning videos to enhance health literacy in LTBI care. The economic analysis supported the use of textual reminders in LTBI treatment as a cost-effective option for widescale implantation. CONCLUSIONS Despite limited evidence on the effects of digital health technologies in LTBI, available studies suggest they are at least equivalent to current practice. This means digital health can potentially supplement current practice, to constantly monitor and engage with people undergoing LTBI screening or treatment, as an initiative to ensure the provision of continuous and optimal care to all LTBI-affected individuals.
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Affiliation(s)
- Yen Jun Wong
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Khuen Yen Ng
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia
| | - Shaun Wen Huey Lee
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; Gerontechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Jalan Lagoon Selatan, 47500 Bandar Sunway, Selangor, Malaysia; School of Pharmacy, Taylor's University Lakeside Campus, Jalan Taylors, 47500 Selangor, Malaysia; Center for Global Health, University of Pennsylvania, PA, USA.
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17
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Semitala FC, Musinguzi A, Ssemata J, Welishe F, Nabunje J, Kadota JL, Berger CA, Katamba A, Kiwanuka N, Kamya MR, Dowdy D, Cattamanchi A, Katahoire AR. Acceptance and completion of rifapentine-based TB preventive therapy (3HP) among people living with HIV (PLHIV) in Kampala, Uganda-patient and health worker perspectives. Implement Sci Commun 2021; 2:71. [PMID: 34193311 PMCID: PMC8247167 DOI: 10.1186/s43058-021-00173-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 06/09/2021] [Indexed: 11/25/2022] Open
Abstract
Background A 12-dose, once-weekly regimen of isoniazid and rifapentine (3HP) is effective in preventing tuberculosis (TB) among people living with HIV (PLHIV). We sought to identify potential barriers to and facilitators of acceptance and completion of 3HP treatment from the perspective of people living with HIV (PLHIV) and health workers in a routine HIV care setting in Kampala, Uganda. Methods We conducted semi-structured interviews with 25 PLHIV and 10 health workers at an HIV/AIDS clinic in Kampala, Uganda. For both groups, we explored their understanding and interpretations of TB and TB preventive therapy (TPT), and perceptions about social and contextual factors that might influence the willingness of PLHIV to initiate and complete 3HP. We analyzed the data using an inductive thematic approach and aligned the emergent themes to the Behavior Change Wheel framework to identify sources of behavior and targeted behavior change interventions. Results Facilitators of acceptance and completion of 3HP treatment among PLHIV were fear of contracting TB, awareness of being at risk of getting TB, willingness to take TPT, trust in health workers, and the perceived benefits of directly observed therapy (DOT) and self-administered therapy (SAT) 3HP delivery strategies. Barriers included inadequate understanding of TPT, fear of potential side effects, concerns about the effectiveness of 3HP, and the perceived challenges of DOT or SAT. Among health workers, perceived facilitators included knowledge that TB is a common cause of mortality for PLHIV, fear of getting TB, and trust in the health workers by PLHIV, the advantages of once-weekly 3HP dosing, and the benefits of DOT and SAT 3HP delivery strategies. Health worker-reported barriers for PLHIV included inadequate understanding of TB and benefits of TPT, TB-associated stigma, potential side effects pill burden, and challenges of DOT and SAT 3HP delivery strategies. Lack of experience in the use of digital technology to monitor patient care was identified as a health worker-specific barrier. Identified intervention functions to address the facilitators or barriers included education, persuasion, environmental restructuring, enablement, and training. Conclusions Using a formative qualitative and comprehensive theoretical approach, we identified key barriers, facilitators, and appropriate interventions, including patient education, enhancing trust, and patient-centered treatment support that could be used to optimize the delivery of 3HP to PLHIV in our setting. These interventions are likely generalizable to other clinical interventions in similar populations in sub-Saharan Africa and other TB high-burden settings. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00173-2.
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Affiliation(s)
- Fred C Semitala
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. .,Makerere University Joint AIDS Program (MJAP), Kampala, Uganda. .,Infectious Diseases Research Collaboration, Kampala, Uganda.
| | | | - Jackie Ssemata
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Fred Welishe
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Juliet Nabunje
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Jillian L Kadota
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Christopher A Berger
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA
| | - Achilles Katamba
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses R Kamya
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Infectious Diseases Research Collaboration, Kampala, Uganda
| | - David Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adithya Cattamanchi
- Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California San Francisco, San Francisco, CA, USA.,Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda.,Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, USA
| | - Anne R Katahoire
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
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18
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Donahue ML, Eberly MD, Rajnik M. Tele-TB: Using TeleMedicine to Increase Access to Directly Observed Therapy for Latent Tuberculosis Infection. Mil Med 2021; 186:25-31. [PMID: 33499464 DOI: 10.1093/milmed/usaa300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 08/05/2020] [Accepted: 10/20/2020] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Treatment of latent tuberculosis infection (LTBI) decreases risk of progression to active tuberculosis. Traditional treatment regimens required either daily isoniazid for 9 months, with historically poor compliance, or 12-week directly observed therapy (DOT) with isoniazid and rifapentine, with improved compliance but additional challenges of coordinating weekly clinic visits, further complicated if patients must travel a great distance for care. MATERIALS AND METHODS Our referral area is complicated by congested traffic often resulting in one-way commutes, which can exceed 2 hours. These travel times would be prohibitive for conducting weekly in-clinic DOT. In an effort to improve access to DOT, we implemented TeleMedicine LTBI DOT (vDOT) within a military pediatric infectious diseases clinic. Patients aged 24 months or older diagnosed with LTBI were referred for possible enrollment into our vDOT clinic. All patients without contraindications for receiving isoniazid and/or rifapentine were offered LTBI treatment via weekly vDOT or daily treatment with isoniazid or rifampin. The first visit for vDOT patients was performed in person to discuss treatment options, demonstrate use of TeleMedicine software, and ensure the patient was able to take the medications. Baseline information about patients and travel time to our facility was determined. RESULTS To date, 16 patients have completed LTBI therapy using vDOT. Average one-way travel time to our facility for patients was 51 minutes. Actual time spent in most vDOT encounters was less than 10 minutes. Appointments were arranged to take place outside usual school and work hours so patients could complete vDOT with minimal interruptions to daily life, resulting in 100% treatment compliance and completion. DISCUSSION Conducting LTBI DOT using TeleMedicine is a viable and time-saving measure that still allows for high levels of patient compliance and treatment completion while minimizing interruptions to academic and work schedules.
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Affiliation(s)
- Megan L Donahue
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Matthew D Eberly
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Michael Rajnik
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Winchester NE, Maldarelli F, Mejia Y, Dee N, Dewar R, Laidlaw E, Kuriakose SS, Stoll P, Proschan M, Lane HC, Pau AK. Eight-day Inpatient Directly Observed Therapy for Antiretroviral Therapy (ART) Failure: A Tool For Preventing Unnecessary ART Changes and Optimizing Adherence Support. Clin Infect Dis 2021; 70:1222-1225. [PMID: 31298273 DOI: 10.1093/cid/ciz590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/10/2019] [Indexed: 11/13/2022] Open
Abstract
Eight-day inpatient directly observed therapy confirmed nonadherence as the major cause of virologic failure for 9 (45%) of 20 highly treatment-experienced persons with human immunodeficiency virus, extensive antiretroviral drug resistance, and high self-reported adherence rates, preventing unnecessary regimen changes.
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Affiliation(s)
| | | | - Yolanda Mejia
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Nicola Dee
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Robin Dewar
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | | | - Safia S Kuriakose
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, National Cancer Institute, Bethesda, Maryland
| | - Pamela Stoll
- Clinical Center, National Institutes of Health, Bethesda, Maryland
| | | | - H Clifford Lane
- National Institute of Allergy and Infectious Diseases, Bethesda
| | - Alice K Pau
- National Institute of Allergy and Infectious Diseases, Bethesda
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Leibowitz A, Satre DD, Lu W, Weisner C, Corriveau C, Gizzi E, Sterling S. A Telemedicine Approach to Increase Treatment of Alcohol Use Disorder in Primary Care: A Pilot Feasibility Study. J Addict Med 2021; 15:27-33. [PMID: 32467415 PMCID: PMC7704783 DOI: 10.1097/adm.0000000000000666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Unhealthy drinking is a leading threat to health, yet few people with alcohol use disorder (AUD) receive treatment. This pilot tested the feasibility of addiction medicine video consultations in primary care for improving AUD medication adoption and specialty treatment initiation. METHODS Primary care providers (PCPs) received training and access to on-call addiction medicine consultations. Feasibility measures were training attendance, intention to use the service and/or AUD pharmacotherapy, and user feedback. Secondary outcomes were utilization, prescription and treatment initiation rates, and case reports. χ2 tests were used to compare prescription and treatment initiation rates for consult recipients and non-recipients. RESULTS Ninety-one PCPs (71.1%) attended a training, and 60 (65.9%) provided feedback. Of those, 37 (64.9%) mentioned pharmacotherapy and 41 (71.9%) intended to use the video consult service. Of 27 users, 19 provided feedback; 12 (63.1%) rated its value at 8 or above, on a scale of 1 to 10 (average 6.9). The most useful aspect was immediacy, and users wanted an easier workflow and increased consultant availability. Of 32 patients who received a consult, 11 (34.4%) were prescribed naltrexone, versus 43 (6.4%) of non-recipients (P < 0.0001); 11 (34.4%) initiated specialty treatment, versus 105 (19.7%) of non-recipients (P < 0.05). CONCLUSIONS PCP training attendance and feedback suggest that an addiction telemedicine consult service would be valuable to PCPs and might increase AUD medication uptake and specialty addiction treatment initiation. However, future research should include significant modifications to the piloted telemedicine model: robust staffing and simpler, more flexible methods for PCPs to obtain consults.
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Affiliation(s)
- Amy Leibowitz
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143
| | - Wendy Lu
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403
| | - Constance Weisner
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403
| | - Caroline Corriveau
- The Permanente Medical Group, Addiction Medicine and Recovery Services, 380 W MacArthur Blvd, Oakland, CA 94609
| | - Elio Gizzi
- The Permanente Medical Group, East Bay Technology, 901 Nevin Avenue, Richmond, CA 94801
| | - Stacy Sterling
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, 3rd Floor, Oakland, CA 94612-2403
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21
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Creary S, Chisolm D, Stanek J, Neville K, Garg U, Hankins JS, O'Brien SH. Measuring hydroxyurea adherence by pharmacy and laboratory data compared with video observation in children with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28250. [PMID: 32386106 DOI: 10.1002/pbc.28250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hydroxyurea nonadherence is common among children with sickle cell disease (SCD), but it is unclear if current adherence measures are valid compared with video directly observed therapy (VDOT), a reference method. The objectives were to evaluate if hydroxyurea adherence by pharmacy records, urine assay, mean corpuscular volume (MCV), and/or fetal hemoglobin (HbF) correlated with and was sensitive and specific compared with VDOT. METHODS This was a cross-sectional analysis of adherence data from 34 children with SCD on a single-arm, six-month hydroxyurea adherence study. Spearman correlation coefficient compared participants' adherence by pharmacy records, MCV, and HbF to adherence by VDOT. The sensitivity and specificity of ≥80% adherence by pharmacy records, two urine samples with hydroxyurea, MCV ≥100 fl/L, and HbF ≥20% compared with ≥80% VDOT adherence were also calculated. RESULTS Median pharmacy and VDOT adherence rates were similar (87.8% vs 88.1%, P = 0.75) and mildly correlated (rs = 0.45; P = 0.008) but the sensitivity of ≥80% adherence by pharmacy records was 72.7% and specificity was 45.5%. MCV (rs = -0.02, P = 0.92) and HbF (rs = -0.2, P = 0.33) did not significantly correlate with VDOT adherence. Sensitivity and specificity were 83.3% and 33.3% for having two urine samples with hydroxyurea, 35% and 71.4% for MCV ≥100 fl/L, and 75% and 0% for HbF ≥20%, respectively. CONCLUSIONS Commonly used tools to measure hydroxyurea adherence may not correlate with or be valid compared with video adherence. Future studies to refine these measures are needed to effectively target adherence interventions to children with SCD who have the potential to benefit. (ClinicalTrials.gov NCT02578017).
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Affiliation(s)
- Susan Creary
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.,Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Deena Chisolm
- Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Joseph Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Kathleen Neville
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Uttam Garg
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, Missouri
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Sarah H O'Brien
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.,Center for Innovation in Pediatric Practice, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
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22
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Guo X, Yang Y, Takiff HE, Zhu M, Ma J, Zhong T, Fan Y, Wang J, Liu S. A Comprehensive App That Improves Tuberculosis Treatment Management Through Video-Observed Therapy: Usability Study. JMIR Mhealth Uhealth 2020; 8:e17658. [PMID: 32735222 PMCID: PMC7428914 DOI: 10.2196/17658] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 04/23/2020] [Accepted: 06/03/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Treatment of pulmonary tuberculosis (TB) requires at least six months and is compromised by poor adherence. In the directly observed therapy (DOT) scheme recommended by the World Health Organization, the patient is directly observed taking their medications at a health post. An alternative to DOT is video-observed therapy (VOT), in which the patients take videos of themselves taking the medication and the video is uploaded into the app and reviewed by a health care worker. We developed a comprehensive TB management system by using VOT that is installed as an app on the smartphones of both patients and health care workers. It was implemented into the routine TB control program of the Nanshan District of Shenzhen, China. OBJECTIVE The aim of this study was to compare the effectiveness of VOT with that of DOT in managing the treatment of patients with pulmonary TB and to evaluate the acceptance of VOT for TB management by patients and health care workers. METHODS Patients beginning treatment between September 2017 and August 2018 were enrolled into the VOT group and their data were compared with the retrospective data of patients who began TB treatment and were managed with routine DOT between January 2016 and August 2017. Sociodemographic characteristics, clinical features, treatment adherence, positive findings of sputum smears, reporting of side effects, time and costs of transportation, and satisfaction were compared between the 2 treatment groups. The attitudes of the health care workers toward the VOT-based system were also analyzed. RESULTS This study included 158 patients in the retrospective DOT group and 235 patients in the VOT group. The VOT group showed a significantly higher fraction of doses observed (P<.001), less missed observed doses (P<.001), and fewer treatment discontinuations (P<.05) than the DOT group. Over 79.1% (186/235) of the VOT patients had >85% of their doses observed, while only 16.4% (26/158) of the DOT patients had >85% of their doses observed. All patients were cured without recurrences. The VOT management required significantly (P<.001) less median patient time (300 minutes vs 1240 minutes, respectively) and transportation costs (¥53 [US $7.57] vs ¥276 [US $39.43], respectively; P<.001) than DOT. Significantly more patients (191/235, 81.3%) in the VOT group preferred their treatment method compared to those on DOT (37/131, 28.2%) (P<.001), and 92% (61/66) of the health care workers thought that the VOT method was more convenient than DOT for managing patients with TB. CONCLUSIONS Implementation of the VOT-based system into the routine program of TB management was simple and it significantly increased patient adherence to their drug regimens. Our study shows that a comprehensive VOT-based TB management represents a viable and improved evolution of DOT.
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Affiliation(s)
- Xujun Guo
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Yarui Yang
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Howard E Takiff
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China.,Pathogenomique Mycobacterienne Integree, Institut Pasteur, Paris, France.,Laboratorio de Genética Molecular, Instituto Venezolano de Investigaciones Cientificas, Caracas, Venezuela
| | - Minmin Zhu
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Jianping Ma
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Tao Zhong
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Yuzheng Fan
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Jian Wang
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
| | - Shengyuan Liu
- Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, Shenzhen, China
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23
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Manyazewal T, Woldeamanuel Y, Holland DP, Fekadu A, Blumberg HM, Marconi VC. Electronic pillbox-enabled self-administered therapy versus standard directly observed therapy for tuberculosis medication adherence and treatment outcomes in Ethiopia (SELFTB): protocol for a multicenter randomized controlled trial. Trials 2020; 21:383. [PMID: 32370774 PMCID: PMC7201596 DOI: 10.1186/s13063-020-04324-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To address the multifaceted challenges associated with tuberculosis (TB) in-person directly observed therapy (DOT), the World Health Organization recently recommended that countries maximize the use of digital adherence technologies. Sub-Saharan Africa needs to investigate the effectiveness of such technologies in local contexts and proactively contribute to global decisions around patient-centered TB care. This study aims to evaluate the effectiveness of pillbox-enabled self-administered therapy (SAT) compared to standard DOT on adherence to TB medication and treatment outcomes in Ethiopia. It also aims to assess the usability, acceptability, and cost-effectiveness of the intervention from the patient and provider perspectives. METHODS This is a multicenter, randomized, controlled, open-label, superiority, effectiveness-implementation hybrid, mixed-methods, two-arm trial. The study is designed to enroll 144 outpatients with new or previously treated, bacteriologically confirmed, drug-sensitive pulmonary TB who are eligible to start the standard 6-month first-line anti-TB regimen. Participants in the intervention arm (n = 72) will receive 15 days of HRZE-isoniazid, rifampicin, pyrazinamide, and ethambutol-fixed-dose combination therapy in the evriMED500 medication event reminder monitor device for self-administration. When returned, providers will count any remaining tablets in the device, download the pill-taking data, and refill based on preset criteria. Participants can consult the provider in cases of illness or adverse events outside of scheduled visits. Providers will handle participants in the control arm (n = 72) according to the standard in-person DOT. Both arms will be followed up throughout the 2-month intensive phase. The primary outcomes will be medication adherence and sputum conversion. Adherence to medication will be calculated as the proportion of patients who missed doses in the intervention (pill count) versus DOT (direct observation) arms, confirmed further by IsoScreen urine isoniazid test and a self-report of adherence on eight-item Morisky Medication Adherence Scale. Sputum conversion is defined as the proportion of patients with smear conversion following the intensive phase in intervention versus DOT arms, confirmed further by pre-post intensive phase BACTEC MGIT TB liquid culture. Pre-post treatment MGIT drug susceptibility testing will determine whether resistance to anti-TB drugs could have impacted culture conversion. Secondary outcomes will include other clinical outcomes (treatment not completed, death, or loss to follow-up), cost-effectiveness-individual and societal costs with quality-adjusted life years-and acceptability and usability of the intervention by patients and providers. DISCUSSION This study will be the first in Ethiopia, and of the first three in sub-Saharan Africa, to determine whether electronic pillbox-enabled SAT improves adherence to TB medication and treatment outcomes, all without affecting the inherent dignity and economic wellbeing of patients with TB. TRIAL REGISTRATION ClinicalTrials.gov, NCT04216420. Registered on 2 January 2020.
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Affiliation(s)
- Tsegahun Manyazewal
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Yimtubezinash Woldeamanuel
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, P.O. Box 9086, Addis Ababa, Ethiopia
| | - David P. Holland
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30322 USA
| | - Abebaw Fekadu
- Addis Ababa University, College of Health Sciences, Center for Innovative Drug Development and Therapeutic Trials for Africa, P.O. Box 9086, Addis Ababa, Ethiopia
| | - Henry M. Blumberg
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30322 USA
| | - Vincent C. Marconi
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, GA 30322 USA
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Harries AD, Kumar AM, Satyanarayana S, Thekkur P, Lin Y, Dlodlo RA, Khogali M, Zachariah R. The Growing Importance of Tuberculosis Preventive Therapy and How Research and Innovation Can Enhance Its Implementation on the Ground. Trop Med Infect Dis 2020; 5:tropicalmed5020061. [PMID: 32316300 PMCID: PMC7345898 DOI: 10.3390/tropicalmed5020061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 02/06/2023] Open
Abstract
Ending the tuberculosis (TB) epidemic by 2030 requires two key actions: rapid diagnosis and effective treatment of active TB and identification and treatment of latent TB infection to prevent progression to active disease. We introduce this perspective by documenting the growing importance of TB preventive therapy on the international agenda coupled with global data showing poor implementation of preventive activities in programmatic settings. We follow this with two principal objectives. The first is to examine implementation challenges around diagnosis and treatment of active TB. Within this, we include recent evidence about the continued morbidity and heightened mortality that persists after TB treatment is successfully completed, thus elevating the importance of TB preventive therapy. The second objective is to outline how current TB preventive therapy activities have been shaped and are managed and propose how these can be improved through research and innovation. This includes expanding and giving higher priority to certain high-risk groups including those with fibrotic lung lesions on chest X-ray, showcasing the need to develop and deploy new biomarkers to more accurately predict risk of disease and making shorter treatment regimens, especially with rifapentine-isoniazid, more user-friendly and widely available. Ending the TB epidemic requires not only cure of the disease but preventing it before it even begins.
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Affiliation(s)
- Anthony D. Harries
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
- Correspondence: ; Tel.: +44-(0)-1962-714-297
| | - Ajay M.V. Kumar
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
- Yenepoya Medical College, Yenepoya (Deemed to be University), University Road, Deralakatte, Mangalore 575018, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Pruthu Thekkur
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, C-6 Qutub Institutional Area, New Delhi 110016, India
| | - Yan Lin
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
- International Union Against Tuberculosis and Lung Disease, No.1 Xindong Road, Beijing 100600, China
| | - Riitta A. Dlodlo
- International Union Against Tuberculosis and Lung Disease, 68 Boulevard Saint Michel, 75006 Paris, France; (A.M.V.K.); (S.S.); (P.T.); (Y.L.); (R.A.D.)
| | - Mohammed Khogali
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; (M.K.); (R.Z.)
| | - Rony Zachariah
- Special Programme for Research and Training in Tropical Disease (TDR), World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland; (M.K.); (R.Z.)
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25
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Lee Y, Raviglione MC, Flahault A. Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review. J Med Internet Res 2020; 22:e15727. [PMID: 32053111 PMCID: PMC7055857 DOI: 10.2196/15727] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 02/06/2023] Open
Abstract
Background Tuberculosis (TB) is the leading cause of death from a single infectious agent, with around 1.5 million deaths reported in 2018, and is a major contributor to suffering worldwide, with an estimated 10 million new cases every year. In the context of the World Health Organization’s End TB strategy and the quest for digital innovations, there is a need to understand what is happening around the world regarding research into the use of digital technology for better TB care and control. Objective The purpose of this scoping review was to summarize the state of research on the use of digital technology to enhance TB care and control. This study provides an overview of publications covering this subject and answers 3 main questions: (1) to what extent has the issue been addressed in the scientific literature between January 2016 and March 2019, (2) which countries have been investing in research in this field, and (3) what digital technologies were used? Methods A Web-based search was conducted on PubMed and Web of Science. Studies that describe the use of digital technology with specific reference to keywords such as TB, digital health, eHealth, and mHealth were included. Data from selected studies were synthesized into 4 functions using narrative and graphical methods. Such digital health interventions were categorized based on 2 classifications, one by function and the other by targeted user. Results A total of 145 relevant studies were identified out of the 1005 published between January 2016 and March 2019. Overall, 72.4% (105/145) of the research focused on patient care and 20.7% (30/145) on surveillance and monitoring. Other programmatic functions 4.8% (7/145) and electronic learning 2.1% (3/145) were less frequently studied. Most digital health technologies used for patient care included primarily diagnostic 59.4% (63/106) and treatment adherence tools 40.6% (43/106). On the basis of the second type of classification, 107 studies targeted health care providers (107/145, 73.8%), 20 studies targeted clients (20/145, 13.8%), 17 dealt with data services (17/145, 11.7%), and 1 study was on the health system or resource management. The first authors’ affiliations were mainly from 3 countries: the United States (30/145 studies, 20.7%), China (20/145 studies, 13.8%), and India (17/145 studies, 11.7%). The researchers from the United States conducted their research both domestically and abroad, whereas researchers from China and India conducted all studies domestically. Conclusions The majority of research conducted between January 2016 and March 2019 on digital interventions for TB focused on diagnostic tools and treatment adherence technologies, such as video-observed therapy and SMS. Only a few studies addressed interventions for data services and health system or resource management.
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Affiliation(s)
- Yejin Lee
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland
| | - Mario C Raviglione
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland.,Centre for Multidisciplinary Research in Health Science (MACH), Università di Milano, Milan, Italy
| | - Antoine Flahault
- Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Global Studies Institute, University of Geneva, Geneva, Switzerland
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Garfein RS, Doshi RP. Synchronous and asynchronous video observed therapy (VOT) for tuberculosis treatment adherence monitoring and support. J Clin Tuberc Other Mycobact Dis 2019; 17:100098. [PMID: 31867442 PMCID: PMC6904830 DOI: 10.1016/j.jctube.2019.100098] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Directly observed therapy (DOT) for monitoring tuberculosis (TB) treatment is intended to reduce disease transmission, mortality and acquired drug resistance by facilitating treatment adherence and support. Synchronous (S-VOT) and asynchronous (A-VOT) video observed therapy are mHealth solutions for remotely monitoring medication ingestion. This paper synthesizes literature through December 2018 to describe existing VOT approaches, summarize evidence, identify knowledge gaps, evaluate VOT strengths and weaknesses, and examine patient and provider factors influencing VOT feasibility and acceptability. High rates of adherence and patient acceptance were obtained using both VOT methods. VOT reduced travel time for TB program staff and/or patients, improving program efficiency compared to in-person DOT while maintaining high patient satisfaction. The impact of VOT on TB treatment outcomes, such as cure and relapse, require further study with longer follow-up. Individual patient, provider and program factors should be considered in selecting either or both VOT approaches for provision of patient-centered care.
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Affiliation(s)
- Richard S. Garfein
- Division of Epidemiology, School of Medicine, University of California San Diego, 9500 Gilman Drive, Mailcode-0725, La Jolla, CA 92093-0725, USA
| | - Riddhi P. Doshi
- Division of Behavioral Sciences and Community Health, School of Dental Medicine, University of Connecticut Health Center, 263 Farmington Avenue, MC 6030, Farmington, CT 06030, USA
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27
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Acceptability, benefits, and challenges of video consulting: a qualitative study in primary care. Br J Gen Pract 2019; 69:e586-e594. [PMID: 31160368 PMCID: PMC6617540 DOI: 10.3399/bjgp19x704141] [Citation(s) in RCA: 290] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 02/18/2019] [Indexed: 11/05/2022] Open
Abstract
Background People increasingly communicate online, using visual communication mediums such as Skype and FaceTime. Growing demands on primary care services mean that new ways of providing patient care are being considered. Video consultation (VC) over the internet is one such mode. Aim To explore patients’ and clinicians’ experiences of VC. Design and setting Semi-structured interviews in UK primary care. Method Primary care clinicians were provided with VC equipment. They invited patients requiring a follow-up consultation to an online VC using the Attend Anywhere web-based platform. Participating patients required a smartphone, tablet, or video-enabled computer. Following VCs, semi-structured interviews were conducted with patients (n = 21) and primary care clinicians (n = 13), followed by a thematic analysis. Results Participants reported positive experiences of VC, and stated that VC was particularly helpful for them as working people and people with mobility or mental health problems. VCs were considered superior to telephone consultations in providing visual cues and reassurance, building rapport, and improving communication. Technical problems, however, were common. Clinicians felt, for routine use, VCs must be more reliable and seamlessly integrated with appointment systems, which would require upgrading of current NHS IT systems. Conclusion The visual component of VCs offers distinct advantages over telephone consultations. When integrated with current systems VCs can provide a time-saving alternative to face-to-face consultations when formal physical examination is not required, especially for people who work. Demand for VC services in primary care is likely to rise, but improved technical infrastructure is required to allow VC to become routine. However, for complex or sensitive problems face-to-face consultations remain preferable.
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