In 2017, the WHO took the critical steps of acknowledging the need for/impact of adherence interventions and approving certain evidence-based adherence technologies for use with DS-TB patients. In 2018, the Stop TB Partnership, through its TB REACH initiative, has selected and will soon be funding 14 projects demonstrating the feasibility, acceptability, and health outcomes impact of these adherence technologies across a wide range of high burden regions. Finally, and most recently, Unitaid proposes to take the further evaluation and use of these adherence technologies to real scale, soliciting “proposals that could demonstrate the feasibility of using innovative adherence technologies at scale to improve outcomes . . . in supporting MDR-TB treatment, as well as drug-susceptible and preventive treatment.” Final proposals are later this month, however early indications are that there is significant interest and engagement by a wide range of approved technology providers, NGOs/implementation partners, and country programs. As we said, momentum building — and we’re proud to have been a part of it!
Since the launch in the Fall, 2017, we have been assisting the Stop TB Partnership in its TB REACH Wave 6 Call for Proposals. The TB REACH initiative receives funding from the Global Affairs Canada, the Bill and Melinda Gates Foundation, the Indonesia Health Fund, and the United States Agency for International Development to fund and evaluate innovative projects designed to improve detection and treatment of TB. Wave 6, which focuses in part on adherence technologies, has been a huge success! The Stop TB Partnership received over 570 grant proposals, with a total request of more than USD 224 million. Of those 570 proposals, 149 applicants requesting funding were invited to make final proposals — 30% of which were focused on adherence technologies. Ultimately, 15 proposals focused on adherence technologies were funded, with total funding of approximately USD 7.5 million. These 15 projects — many of which involve Wiseill, 99DOTS and SureAdhere technologies, and several of which are led by our friends at KNCV, Aurum, and PATH — will…
- significantly enhance the evidence base supporting the use of adherence technologies in TB treatment
- support demonstrations and trials in a wide range of high burden regions across Asia and Africa
- focus on technology-enabled assistance to particularly challenging patient populations, such as miners and nomadic/indigenous populations.
Congratulations to Stop TB Partnership, TB REACH, and to the many deserving grantees!
Just 4 short years ago, Microsoft researchers in India were ideating around a way to monitor patient adherence to TB medications without requiring clinic visits (DOT), which create challenges for patients and an enormous burden for providers. Building on the idea of sending free messages via “missed calls,” an early 99DOTS prototype was born with handwritten numbers on medication blisters.
Fast forward to today…nearly 200,000 patients are being managed via the highly scalable, highly affordable, patient-centered 99DOTS approach. Read about this journey here: https://news.microsoft.com/en-in/features/99dots-tuberculosis-patients/
The Arcady Group is proud to be supporting and coordinating efforts by technology experts, like those at Everwell Health, global health organizations, researchers, and many others to address the cxhallenge of poor treatment adherence and, thus, reduce the burden, transmission, recurrence, and drug resistance often associated with tuberculosis in resource-limited countries.
Dr. Jessica Haberer presented the talk, “Does the monitoring of medication packaging tell us what we need to know about TB treatment adherence” on October 11, 2017 at the UNION meeting in Guadalajara, Mexico. It was one of four presentations highlighting the use of technology to support TB medication adherence. In the talk, Dr. Haberer summarizes the need for adherence-informed approaches to TB treatment, particularly as programs move away from directly observed therapy and toward self-administered therapy. She reviews several types of electronic adherence monitors (e.g., evriMED, Wisepill) and 99DOTS (a cell phone-based reporting system), all of which can be linked to data-driven, patient-centered intervention within a public health delivery context. Dr. Haberer discusses the evidence for impact from these approaches, as well as accuracy and acceptability to patients. She also comments on use of these approaches at scale and identifies areas for future research and development.
Donors such as Bill & Melinda Gates Foundation, USAID and Global Affairs Canada are supporting the TB REACH Wave 6 initiative to fund innovation and research to (i) improve detection, linkage to treatment and reporting of TB, and (ii) improve TB treatment adherence and outcomes. The Arcady Group founder, Bruce Thomas, helped launch the Wave 6 call, presenting an overview of the TB adherence technologies and highlighting areas of interest and focus for Wave 6 applicants.
The presentation concluded with the following recommendations for country programs interested in gaining experience with, and insights about, the acceptability and impact of adherence technologies:
- Proposals utilizing and evaluating adherence technologies and technology-enhanced patient management are invited/encouraged.
- Although 99DOTS, V-DOT, and evriMED are of particular interest, proposals involving other technologies/approaches also are invited.
- It is desirable to have work done in, and have strong involvement from, high burden country programs.
To find out more: https://lnkd.in/dAb24R7.
The Arcady Group founder, Bruce Thomas, led the Stop TB Partnership’s Focus Group Workshop On Digital Adherence Technologies. At this meeting, innovators such as Everwell Health (99DOTS), Wisepill Technologies (evriMED medication monitor), Keheala (SMS-based behavioral counseling) and SureAdhere Mobile Technology (V-DOT) were connected with representatives of key NGO implementers and country programs (including Zimbabwe, Philippines, Moldova, and South Africa) to discuss opportunities for experimentation and uptake of digital adherence technologies through TB REACH Wave 6 grants. Bruce and Ram Subbaraman shared new evidence and insights about the importance of treatment adherence to avoid TB relapse. Download our presentation slides here.
The Arcady Group’s work is collaborative in nature. We know that radical change in global health only comes from multiple stakeholder groups coming together with a shared vision and commitment to action.
The Stop TB Partnership recently published a news article on their site entitled, “Stop TB Partnership’s TB REACH initiative funds innovation and fosters grantee-grantee collaboration.” In the article, they highlight Scientific Animations without Borders (SAWBO) and Stony Brook University’s Global Health Institute as organizations working to diagnose, educate and treat tuberculosis. The two groups recognized synergies in their projects and have been sharing expertise and resources to advance their missions.
The Arcady Group, with funding from the Bill & Melinda Gates Foundation, arranged for evriMED medication event monitors to be used as part of the Stony Brook project. The technology is helping to connect individuals with TB in remote Madagascar to central laboratories by collecting data on medication adherence and enabling dose-history driven interventions and differentiated care.
We are pleased to announce the publication of “Usability of a Medication Event Reminder Monitor System (MERM) by Providers and Patients to Improve Adherence in the Management of Tuberculosis” in the International Journal of Environmental Research and Public Health. This contributes to the growing body of evidence supporting scale up on the Bill & Melinda Gates Foundation-funded, Wisepill Technologies-developed evriMED digital medication monitor. The newly published manuscript summarizes the approach and results of a formal usability evaluation that was conducted by the China CDC and represents a best practice in implementation science regarding adherence technologies. The evaluation sought to understand MERM user performance, satisfaction, and acceptability to both TB patients and TB providers in a rural setting in China.
“The patients themselves reported that the MERM was easy to use and improved their adherence and their experience of taking their medications, thereby enhancing their quality of life and that of their families. The medical staff also reported that it reduced the workload and increased their job satisfaction.”
Additional studies are underway in China evaluating the impact of these adherence technologies on patient adherence (including persistence) and evaluating whether and to what extent improving adherence is related to better health outcomes for patients.
We are committed to making the most current TB medication adherence resources readily available for stakeholders in Global Health! Our partner, Ramnath Subbaraman, recently co-authored a chapter in the third edition of GP Clinics “Let’s Talk TB,” a textbook supplement for general practitioners in India.
The chapter discusses monitoring technologies, such as cell phone-based strategies and electronic pillboxes, as tools that can facilitate identification of patient medication non-adherence.
Once identified, the authors stress the importance of an interdisciplinary approach to improving TB medication adherence. More specifically, they suggest a four-pronged approach that includes tackling the clinical and social determinants of non-adherence: drug toxicities, nutrition, comorbidities and psychosocial barriers.
To download the article or read the abstract visit our Global Access Resources page.
Several significant and positive changes with respect to adherence, adherence interventions, adherence technologies, and medication monitors in particular were included in the newly released WHO 2017 Update on Guidelines for DS-TB Treatment. These guidelines make several important points about the importance of TB treatment adherence, about the impact of various adherence interventions, and about the promising role of digital technologies in achieving improved treatment outcomes and reduced disease morbidity. Importantly, the guidelines contain the first-ever WHO evidence-based recommendations on the use of, among other approaches, digital medication monitors to help patients adhere to TB medication and deliver TB care. These guidelines and new recommendations represent a significant and positive step forward with respect to adherence interventions generally — acknowledging that some form of adherence intervention is, in essence, required in order to ensure good TB treatment outcomes. In addition, these guidelines make clear that that digital medication monitors such as the evriMED devices (www.wisepill.com) developed with support from the Bill & Melinda Gates Foundation, have been “approved for use” pursuant to these new guidelines.