What are Digital Adherence Technologies?
Digital adherence technologies (DATs) are tools designed to support people with TB with taking their medications. Compared to traditional directly observed therapy (DOT), the tools allow for people to take their medications at a place and time that is convenient to them, while remaining connected to their health care provider. For health care providers, DATs can facilitate the identification of high-risk patients who may need additional in-person support.
DATs have been deployed at both small and large-scale in different contexts with a growing body of evidence around them to support person-centered care in TB and have been endorsed by the World Health Organization (WHO).
There are currently several different types of DATs available, including three described in the WHO Handbook for the use of digital technologies to support tuberculosis medication adherence:
Medication sleeves: Medication sleeves combine customized packaging and utilize free or low-cost interactions such as phone calls, SMS, USSD, or other messaging technology.
Smart pill boxes: Smart pill boxes employ electronic sensors that can provide treatment reminders and that automatically log daily doses via a mobile internet connection.
Video-supported treatment: Video-supported treatment utilizes a video connection between the person with TB and the health care provider to observe medication intake remotely.
A function that all types of DATs have in common is the ability to generate a digital record of medication intake. When different types of DATs are implemented in a country context, all data is combined into a DAT platform. Health care workers can monitor adherence via a single user interface to support people with TB on their treatment journey.
Aggregated adherence data at the country level contributes to a better understanding of the challenges people with TB face on their treatment journey across geographies and over the course of treatment. Integration of multiple types of DATs through a standardized platform creates the opportunity to use different technologies depending on which is more appropriate for a population, as well as to switch between them, without sacrificing the functionality and data utilization of the platform. Lastly, a single, adaptable platform will allow new types of DATs to be added in the future and establish linkages with existing national patient management or disease surveillance systems.
TB REACH's Digital Adherence Technology Projects
TB REACH funded 13 DAT projects for Wave 6. These projects are in 12 different countries across Africa, Latin America, Central Asia and South/South East Asia, target different populations, and using varying tools to promote and assess adherence to TB treatment. The DAT tools include 99DOTS, evriMED, video observed technology (VOT), and other technologies.
The 13 different TB REACH DAT projects provide a unique opportunity to understand the use and implementation of DATs for TB treatment across different settings and contexts.
Lessons learned from these projects will add to the global evidence gap for understanding barriers and facilitators to the implementation and utilization of these tools by persons with TB, providers, and programs.
·Feasibility: extent to which the DAT can be practically used in a setting (e.g., infrastructure, access to technology and networks)
·Acceptability: perceptions about using DATs among both healthcare providers and TB affected people (e.g., perceived ease of use, usefulness, satisfaction, and cultural and social acceptability)
·Accuracy: extent to which the data from the DAT platform accurately reflects whether persons with TB did in fact take their treatment doses.
·Costs: costs associated with implementing DAT projects (e.g., suppliers, resources, and healthcare provider time, costs to the TB affected person)
Global DAT Taskforce
Since 2015, major efforts have been made to accelerate the uptake of digital adherence technologies (DATs) for people-centered tuberculosis (TB) care and treatment modalities. To contribute to the further evaluation of DATs in line with the targets set forth in the Global Plan to End TB and the End TB Strategy, a Global Digital Adherence Technologies Task Force ("DAT Task Force") was established in July 2020.
As a broad group of global partners and stakeholders from multiple organizations, we share the common goal of seeing a world where TB is no longer prevalent. Our approach is to contribute to the further evaluation of DATs as a tool to support TB treatment, optimal introduction and scale-up of DATs in the context of people-centered treatment and care modalities, and the further innovation of DATs and supporting and enabling tools, processes, and systems. While continuing the evaluation and research of DATs in practice, we offer technical support for the optimal introduction and scale-up of DATs for national TB programmes. Further information about the DAT Task Force can be found on the DAT Task Force website.
For any questions related to the DAT Task Force, DAT implementation and resources, please contact the DAT Task Force Coordinator at https://tbdigitaladherence.org/contact/.
Virtual Innovation Spotlights on DATs
In order to support country programmes, healthcare providers, the communities and people affected by TB and our partners during COVID-19, the EASI team and, as part of its Re-imagining TB Care initiative, organized a series of "virtual innovation spotlights" (VIS) to present and share various digital health technologies, including DATs, that could be used to:
· Mitigate interruptions in TB services during COVID-19 and
· Lay the groundwork to pivot TB care to become more virtual, integrated and on-demand.
Resources for evidence generation, implementation, policy and funding, market access, technology innovation and process, and advocacy, communication and demand generation can be found at https://tbdigitaladherence.org/ and here.