Peter Small, who has led the call for more patient-centered ways of assisting TB patients with treatment adherence, and who also gave me the opportunity and funding (through the Bill & Melinda Gates Foundation) to help try to meet that need, continues his passionate advocacy for patients and for medication adherence. In RockyTalks, Peter shares how emerging technology (including Wisepill’s evriMed device designed to assist DR-TB patients) and other evolving health systems and technologies can make it easier.
Thanks, Peter, for your passionate and creative leadership and advocacy!
Earlier this year, Arcady Founder, Bruce Thomas presented at the HealthXL Global Gathering in Melbourne, Australia. HealthXL Global Gatherings showcase innovation on a global platform by bringing together people with ideas, resources and desire to contribute to the evolution of healthcare. This year’s event assembled leaders and innovators of the world’s most disruptive health technology companies to share stories and insights.
Bruce shared Arcady’s work over the last 4 years to coordinate the use of adherence technologies to provide evidence-based differentiated care to patients on TB treatment in high burden regions of the world. Attendees learned about the progress that has been made in incredibly challenging settings with incredibly challenging patient populations. Many left with the perspective that we certainly shouldn’t be struggling to tackle these issues (patient-centered, technology-enabled, evidence-based differentiated care) in geographies where technologies and resources are available in abundance!
The Arcady Group, LLC, a consulting company that works to enhance patient and disease management by addressing the challenges of medication non-adherence, has been awarded a grant from the Bill & Melinda Gates Foundation to continue Arcady’s activities to improve TB medication adherence and TB treatment outcomes. Under this most recent grant, the third from the Foundation, Arcady will be focused primarily on the further scaled deployment and systematic evaluation of patient-centric, highly affordable, highly scalable medication adherence-monitoring technologies for use with TB patients in high burden regions worldwide.
Since 2014, The Arcady Group has led and coordinated efforts to develop, evaluate, and deploy more patient-centric, more effective approaches to TB medication adherence enhancement and TB patient management. Over the last 4 years, several innovative, affordable, scalable adherence technologies have been developed, evaluated extensively in India and China, and approved for use by the World Health Organization (“WHO”). Under this most recent grant, The Arcady Group will collaborate with country programs and with organizations such as UNTAID and Stop TB Partnership to evaluate the few remaining questions regarding the use and impact of these technologies and approaches, to secure additional support from WHO for the use of these technologies and approaches as “standard of care,” and to deploy these technologies and approaches at global scale.
“Over the past 4 years, tremendous progress has been made in understanding the critical importance of adherence in TB, developing far more patient centric solutions to current monitoring practices, generating evidence supporting both the acceptability of these solutions with patients and the effectiveness of these solutions in enhancing TB medication adherence, and securing WHO approval as well as support from other key global health organizations. With this grant, we can now focus on the very exciting part of this multi-year project – actually getting these solutions deployed as standard of care in the treatment of TB patients in high burden regions around the world.”
Continuing, Mr. Thomas stated: “On behalf of my colleagues at The Arcady Group, and all of our great collaborators and partners these past several years, I’d like to express our appreciation for, and acknowledge the incredible support we and others have received from, the Bill & Melinda Gates Foundation since 2014. Largely through their support, an entirely new, more patient-centric, more effective way of managing TB patients has been developed, evaluated, approved, and deployed – to those in the greatest need. We are honored to have played a role in these efforts and along that incredible journey. For many, perhaps most of us, it has been the capstone and proudest achievement of our careers.”
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!
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.