Relationship Between Medication Adherence and Treatment Outcomes: The COMBINE Study

Background Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. Objective This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. Methods 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. Results The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. Conclusions We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.

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Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods (Preprint)

10.2196/preprints.19270 ◽

2020 ◽

Author(s):

Devika Patel ◽

Christopher Allen Berger ◽

Alex Kityamuwesi ◽

Joseph Ggita ◽

Lynn Kunihira Tinka ◽

...

Keyword(s):

Medication Adherence ◽

Treatment Outcomes ◽

Health Care Providers ◽

Design Methodology ◽

Health Workers ◽

Design Principles ◽

User Needs ◽

Local Health ◽

Care Providers ◽

Human Centered Design

BACKGROUND Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. OBJECTIVE This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. METHODS 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. RESULTS The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. CONCLUSIONS We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes.

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Medication Adherence to Successful Tuberculosis Treatment Outcome among TB/HIV Patient at Prof. Dr. Sulianti Saroso Infectious Disease Hospital

Pharmacology and Clinical Pharmacy Research ◽

10.15416/pcpr.v5i3.29166 ◽

2020 ◽

Vol 5 (3) ◽

pp. 98

Author(s):

Yusmaniar Yusmaniar ◽

Adin H Kurniawan

Keyword(s):

Infectious Disease ◽

Treatment Outcome ◽

Medication Adherence ◽

Treatment Outcomes ◽

Tuberculosis Treatment ◽

Treatment Results ◽

Hiv Patients ◽

Infectious Disease Hospital ◽

Disease Hospital ◽

Tuberculosis Treatment Outcome

Tuberculosis/Human Immunodeficiency Virus (TB/HIV) co-infection has poorer treatment outcome compared to non-co-infected patients. To benefit from therapy and to avoid contracting treatment-resistant strains, the individuals must adherent to medications. There is limited information regarding successful TB treatment outcomes and their associated factors. Thus, the study was designed to identify medication adherence associated with treatment outcomes among TB/HIV Patients at Prof. Dr. Sulianti Saroso Infectious Disease Hospital. This research was an observational study with retrospective approach from January 2015 to December 2017 by taking data from medical records and TB-01 form of TB/HIV patients in the outpatient clinic of the disease which would be used as a sample. Regarding compliance in treatment with first visit for 2-4 months, an approach using secondary data which were TB-01 Form, as well as HIV Care and Antiretroviral Therapy summary forms was used. The statistical analysis used was the bivariate analysis with the chi-square test as the statistical test. A total of 114 patients were included in the study. The outcome of treatment success obtained from this study had a patient cure rate of 91.30%. There is a significant relationship between medication adherence to successful tuberculosis treatment outcome with p-value= 0.012; OR= 5.684. There is a meaningful relation between medication compliance with treatment outcome. It is when on medication adherence, the treatment results can be declared cured in accordance with predetermined criteria, while when not on medication adherence, the treatment results are not declared cured.

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