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!
Over the past several years, a number of studies have been published demonstrating the feasibility, acceptability, and adherence enhancing impact of medication adherence monitoring technologies on TB medication adherence in high-burden regions. However, none of these studies have evaluated health outcomes as a primary endpoint.
Bruce Thomas, Arcady Founder, is a contributing author for recently published design manuscript outlining in detail the research protocol for such a health outcomes-oriented study. The cluster randomised controlled trial, currently well underway in China, aims to evaluate the impact of a medication monitor-based treatment strategy for drug-sensitive TB patients on a composite poor outcome measured over 18 months from start of TB treatment. Composite poor outcome is being defined as either of poor outcome at the end of treatment (death, treatment failure, or loss to follow-up) or subsequent recurrence (culture positive for TB at 12 or 18 months or re-starting TB treatment in the follow-up period). An economic evaluation will also be conducted as part of this study.
The trial will address an important gap in the current evidence base regarding adherence technologies generally and their use in TB patient management more specifically. It is hoped that the publication of this protocol and discussion thereof will assist and inform other studies currently being planned in a wide range of high burden regions.
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.”
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!
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!
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.