Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities.
Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities.
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DOI：
10.1136/bmjgh-2018-001018
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发表时间：
2018
影响因子：
8.1
通讯作者：
Haberer J
中科院分区：
文献类型：
--
作者：
Subbaraman R;de Mondesert L;Musiimenta A;Pai M;Mayer KH;Thomas BE;Haberer J
药物依从性差可能会增加活动性结核病（TB）患者的失访率、疾病复发率和耐药性。虽然结核病规划在历史上一直使用直接观察治疗（DOT）来解决依从性问题，但人们对患者负担、伦理局限性、改善治疗结果的有效性以及DOT对卫生系统的长期可行性提出了担忧。数字依从性技术（DAT）-包括基于功能手机和智能手机的技术，数字药丸盒和可摄取传感器-可以促进更多以患者为中心的方法来监测依从性，尽管可用数据有限。视乎具体技术而定，DAT可帮助提醒病人服药、促进对服药情况的数字化观察、编制服药史并根据病人的依从性水平对病人进行分流，这有助于结核病规划向不同风险水平的病人提供个性化护理。需要进行研究，以了解DAT是否为患者和医疗保健提供者所接受，是否能准确测量依从性，是否能有效改善治疗结果，是否能有效提高卫生系统效率。在这篇文章中，我们描述的景观DAT正在使用的研究或临床实践的结核病规划和重点研究。
Poor medication adherence may increase rates of loss to follow-up, disease relapse and drug resistance for individuals with active tuberculosis (TB). While TB programmes have historically used directly observed therapy (DOT) to address adherence, concerns have been raised about the patient burden, ethical limitations, effectiveness in improving treatment outcomes and long-term feasibility of DOT for health systems. Digital adherence technologies (DATs)—which include feature phone–based and smartphone-based technologies, digital pillboxes and ingestible sensors—may facilitate more patient-centric approaches for monitoring adherence, though available data are limited. Depending on the specific technology, DATs may help to remind patients to take their medications, facilitate digital observation of pill-taking, compile dosing histories and triage patients based on their level of adherence, which can facilitate provision of individualised care by TB programmes to patients with varied levels of risk. Research is needed to understand whether DATs are acceptable to patients and healthcare providers, accurate for measuring adherence, effective in improving treatment outcomes and impactful in improving health system efficiency. In this article, we describe the landscape of DATs that are being used in research or clinical practice by TB programmes and highlight priorities for research.
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