Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials

• Published in: Journal of medical Internet research 2022-02, Vol.24 (2), p.e33062-e33062
• Main Authors: Ridho, Abdurahman, Alfian, Sofa D, van Boven, Job F M, Levita, Jutti, Yalcin, Esin Aki, Le, Ly, Alffenaar, Jan-Willem, Hak, Eelko, Abdulah, Rizky, Pradipta, Ivan S
• Format: Article
• Language: English
• Subjects: Adherence; Adult; Analysis; Biomedical Technology; Cell Phone; Clinical outcomes; Clinical trials; Completion; Conversion; Cure; Directly observed therapy; Dosage; Drug dosages; Drug resistance; Drug therapy; Drugs; Health status; Humans; Infections; Infectious diseases; Intervention; Medical technology; Medication Adherence; Pathogens; Patient compliance; Population; Randomized Controlled Trials as Topic; Reminder Systems; Reminders; Review; Risk factors; Sensors; Systematic review; Telemedicine; Text Messaging; Treatment Outcome; Tuberculosis
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/33062

Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.47; 95% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. It was found th