Tuberculosis is among the top 10 causes of death worldwide, and last year 10.4 million people fell ill from TB. While there are medications to cure TB, patients don’t always adhere to prescribed therapy. Irregular adherence, even for patients that “complete treatment,” is significantly associated with relapse and drug resistance. Traditionally, patient adherence has been managed through direct observation (DOT), where patients are often required to travel to treatment centers for medical practitioners to watch pill ingestion. Not surprisingly, this method is resource intensive, burdensome for patients, impacts persistence with therapy2 and, in essence, assumes all patients are non-adherent. As part of its ongoing efforts to modernize TB delivery, the Gates Foundation wanted to understand certain key facts regarding TB medication adherence.
Using structured, insights-oriented interviews with patients, providers, disease state experts, and other key stakeholders, we developed a comprehensive adherence fact base regarding TB and TB/HIV co-infection in India, China, and Africa. Specifically, we assembled at a practical and actionable level of detail the key facts around five questions:
- How relatively important is adherence in TB– what level of non-adherence affects health outcomes?
- What is baseline adherence?
- What are the causes of poor adherence?
- What adherence interventions are available or needed? What is their demonstrated/comparative effectiveness? What is their scalability?
- What would be the impact (health outcomes and cost-effectiveness) of a systematic, scalable way to positively impact TB medication adherence?
This fact base served as critical input in our client’s development of a strategy for more patient-centric adherence monitoring as part of a comprehensive strategy to modernize TB delivery in resource limited settings.