JMIR Publications

ABSTRACT

Background:

Non-adherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of non-adherence to medication and improving treatment

Objective:

This article aimed to systematically review the effect of DHT to improve medication adherence and treatment outcomes in patients with TB.

Methods:

A literature search in PubMed and Cochrane databases was performed. We included Randomized Controlled Trials (RCT) that analyzed the effect of DHT interventions in improving adherence to medication and treatment success. Adult TB patients with either active or latent TB infection were included. The JADAD score was used for assessing the quality of the studies. We followed PRISMA to report our findings.

Results:

Sixteen RCTs were selected from 552 studies found. Sixth types of DHT interventions were identified. Several interventions demonstrated positive effects in completing treatment, i.e., video directly observed therapy (VDOT) (Relative Risk (RR) 1.36; 95% Confidence Interval (CI) 1.19-1.55), video observed therapy (VOT) (Odds Ratio (OR) 2.52; 95% CI 1.17-5.54), ingestible sensor (OR 7.69; 95% CI 4.51-14.48), and SMS reminder (RR 1.1; 95% CI 1.04-1.18; RR 1.05; 95% CI 1.04–1.06; OR 2.472; 95% CI 1.133-5.434), while medication monitor box interventions showed protective effects in missing dose of TB medication (Mean Ratio (MR) 0.58; 95% CI 0.42-0.79; MR 0.49; 95% CI 0.27-0.88). However several studies showed the different effects in completing treatment, i.e., VDOT (RR 0.99; 95% CI 0.93-1.05; RR 1.08; 95% CI 0.89-1.32), medication monitor box (RR 0.55; 95% CI 0.21-1.42), and SMS reminder ( RR 1.00; 95% CI 0.79–1.26; RR 0.87; 95% CI 0.81-0.94; OR 1.45; 95% CI 0.81-2.56; RR 0.97; 95% CI 0.88-1.07; RR 0.76; 95% CI 0.18-3.28). In terms of treatment success, phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.472; 95% CI 1.133-5.434) positively affected superior treatment outcomes. However, other studies found that SMS reminders were ineffective on the cure rate (OR 1.06; 95% CI 0.65-1.73; RR 1.05; 95% CI 0.62-1.76) and smear conversion outcomes (RR 1.00; 95% CI 0.90–1.12).

Conclusions:

Although various intervention effects were found in our study, DHT can be a promising approach in improving medication adherence and treatment outcomes. Considering individual factors of non-adherence to medication, developing DHT intervention with personalized feedback is needed to have a consistent and positive effect on medication adherence and treatment outcome among TB patients. Clinical Trial: n/a