Compare Technologies
Considerations
Implementation requirements
Considerations
Before deciding on technology suitability, there are elements that need to be considered in relation to the target population and the country or national TB programme context.
Each consideration is scored according to a favourability scale as low, medium or high. Low indicating less favourability, and high indicating increased favourability compared to the other digital adherence technologies.
These considerations are based on the ASCENT Project Technical Brief, summarizing the implementation experiences with these three technologies in 5 countries.
Medication Sleeves / Labels
Ease for Patient to Use Technology: Medium
- Medication intake is logged daily by the patient making a call or SMS to the unique code.
- Small packaging makes it more versatile for travel purposes and reduces the risk of stigmatization.
Ease for healthcare worker to use technology: Medium
- The healthcare worker will need to repackage medication into the patient sleeves or attach the label with the unique code.
- The HCW will need to ensure patient records are up to date on the adherence platform regularly, particularly the patient cell phone number is correct and has not changed.
Accessibility: Low
- Patients need daily access to a phone that can make calls and/or can send and receive SMSs.
- The patient needs a positive airtime balance daily to report adherence (even though the patient may not be charged for the call or SMS). Adherence reporting may be interrupted if the patient has a zero-airtime balance.
Ease of implementation: Low
- It is administratively heavy to set up the required communication infrastructure for the patient to report adherence.
- A telecom aggregator needs to be appointed to setup and oversee the necessary infrastructure with local telecommunication companies.
- TB medication blister packaging is not standardized, therefore forecasting correct sleeve sizes for printing is very challenging
- Sleeve stock management is difficult as the medication packaging may be different per each new delivery from the Global Drug Facility.
Suitability for use with different drug types: Low
- Only suitable for patients treated with Fixed Dose Combination Medication, and therefore not implementable for patients using multiple pills for their treatment.
Smart Pill Box
Ease for patient to Use Technology: High
- The Smart Pill Box is large and therefore not as versatile for travel purposes.
- The large box increases the risk of stigmatization for the patient.
Ease for healthcare worker to use technology: Medium
- An initial preparation and setup of the device is required before it is ready for distribution. The battery needs to be charged fully, and the medication dosage instructions need to be stuck to the inside of the box.
- If a cardboard box is used it needs to be assembled.
- Upon treatment completion the box and sensor need to be retrieved from the patient, checked that it is still functional, and the box needs to be cleaned (if it is a plastic box).
Accessibility: High
- The patient doesn’t need any additional technology to be able to make use of this DAT – the box is provided by the healthcare facility.
Ease of implementation: Medium
- Manufacturing occurs in South Africa; therefore, lead times may be long, due to production, shipping, importation and distribution.
Suitability for use with different drug types: High
- Suitable across all medication types.
Video Observed Treatment
Ease for Patient to Use Technology: Low
- Patient needs to record daily medication intake by video for the treatment duration.
- Time investment is 3 – 5 minutes daily.
- Patient may feel uncomfortable about privacy associated with video recording themselves.
Ease for healthcare worker to use technology: Low
- Provider needs to review and verify each patient video daily.
- Time investment: 4 – 6 minutes per patient per day (longer if there is a video recording error that needs to be followed up on).
Accessibility: Low
- Patient needs daily access to a smart phone.
- Patient needs daily access to Wi-Fi or data.
- Healthcare provider requires technology to review videos – a smartphone / tablet or computer as well as data or Wi-Fi.
- Country legislation may have restrictions with regards to privacy of video sharing, etc.
Ease of implementation: High
- It does not require any additional action once the video recording adherence app has been installed and the patient has been loaded onto the adherence platform.
Suitability for use with different drug types: High
- Suitable for different medication formulations, such as DR-TB & DS-TB.
Implementation Requirements
Upon implementation there are some prerequisites for each technology. By comparing each technology’s requirements you will be able to make an informed decision about which technology suits your context the best, or which areas still require attention before implementation can be rolled out.
Medication Sleeves / Labels
Phone Access
Patient has access to phone and can make/or receive phone calls or SMSs.
In-Country Communication Infrastructure
Specialized in-country toll-free or SMS-based communication infrastructure.
Production & Distribution
Sleeve or label production facility and distribution.
Adherence platform access for provider
Healthcare provider can use smartphone, tablet, or laptop to access online adherence platform.
Follow-up based on adherence
Targeted follow-up actions and support by healthcare providers and other staff based on adherence.
Smart Pill Box
Follow-up based on adherence
Targeted follow-up actions and support by healthcare providers and other staff based on adherence.
Adherence platform access for provider
Healthcare provider can use smartphone, tablet, or laptop to access online adherence platform.
Video Observed Treatment
Smartphone access
Patient has daily access to a smartphone.
Mobile data or Wi-Fi
Patient has daily access to mobile data / Wi-Fi, throughout treatment.
Server
Secure video storage server has been set-up in country.
Time to review videos
Healthcare provider has sufficient time each day to review patient videos.
Follow-up based on adherence
Targeted follow-up actions and support by healthcare providers and other staff based on adherence.
Adherence platform access for provider
Healthcare provider can use smartphone, tablet, or laptop to access online adherence platform.