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TB remains one of the leading causes of death despite being curable with effective medication. The problem is that these medications have to be taken for multiple months and adhering to this long-term regimen can be challenging. Patients who do not take their medication regularly have not only higher risk of their own preventable death, but could also spread drug-resistant TB to others.
The public health problem with TB is so severe that two systems DOT – Directly Observed Treatment - and VOT- Video Observed Treatment - have been tried. However, both systems demand time and hassle for patients and healthcare professionals. Healthcare professionals still have to have the time to watch, often many patients, taking their pills in person or remotely. And still, at best, VOT has achieved 77% adherence.
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Dr Onno Akkerman, TB pulmonologist in Groningen: "For far too long we have been dependent on classical adherence monitoring systems such as DOT. The DOT system is not only burdensome for us healthcare professionals, but also very paternalistic to patients. Therefore, innovation in this area to provide more patient centred care is urgently required."
The Pill Connect system, which is much simpler than DOT, has proven to be robust and appreciated by end users. It works by sending a daily reminder to the patient's phone who acknowledges the reminder by pushing a response button on their screen. This automatically ejects a pill or tablet from the pill bottle and sends a message to the clinic or surgery that the pill has been dispensed. If the patient does not respond, then the healthcare professional can follow up either immediately or when they next see the patient. TB clinics can monitor a real-time dashboard of all their patients and their adherence pattern.
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The pilot trial which starts in November 2020 involves 12 patients which will, depending upon the outcome, lead to larger trials in other countries. The trial will assess whether the Pill Connect system could provide efficient, remote patient adherence monitoring to eventually improve TB outcomes and reduce healthcare time and costs.
Dr Job van Boven, director of the Medication Adherence Expertise Center: "The Pill Connect system is a really clever mHealth solution that can empower patients, enhance their independency and potentially improve TB outcomes around the globe. The remote medication adherence monitoring option is of even more relevance during the current COVID-19 pandemic."
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