Project Lead(s): Surakameth Mahasirimongkol
Issue
Non-adherence to effective therapies is a major problem against effective control of infectious diseases, such as tuberculosis (TB) and HIV, and management of chronic diseases, such as diabetes and hypertension.
Among TB patients in developing countries worldwide, for example, approximately 20% are non-adherent, leading to prolonged treatment, drug resistance, relapse and death.
The current approaches to improving treatment adherence are: sending out reminders, providing monetary incentive, health education and intensive supervision of adherence.
These are all provider-dominant care strategies, some of which are resource-intensive and have been shown not to be very effective in preventing non-adherence and limiting the effectiveness of the global TB control in the past decades.
Solution
The project idea was to provide a very low-cost, automated reminder/drug-dispensing machine through ‘missed call’ signals that also allow phone calls between patients and clinics, free of charge to the patients, in order to enable them to manage their disease effectively.
A prototype of the device had previously been developed by the team.
This CARE-Box (Connection, Affordable, Reminder and Enabling-Box) consists of a handmade plastic box with an electronic switch attached to a modified, low-cost mobile phone.
The mobile phone in the box was modified so that it would make phone calls to the adherence-monitoring server every time the box was opened and the electronic switch activated.
By pushing a call button, patients could make a phone call directly to the healthcare provider who was trained to provide telephone consultation to the patient.
The idea was to give this affordable device to patients, in order to connect them with clinics without any cost. It also automatically reminds patients to take prescribed medicines at a given set of times every day, thereby enabling them to adhere to necessary therapies.
A randomized controlled trial (RCT) using 50 boxes with 50 patients and 50 control patients was conducted in Chiang Rai, Thailand.
Outcome
The team successfully demonstrated that using a patient-centred approach can increase treatment and medication adherence in patients with pulmonary and extra-pulmonary TB.
The RCT found a 12% significant difference between the intervention and control groups, with a higher proportion of patients with better adherence in the CARE-Box group.
Extensive monitoring and immediate responses to non-adherence was appreciated by patients, increased patient awareness of care by healthcare providers, and resulted in a higher rate of complete adherence.
Additional Funds for the project were requested from the Health System Research Institute in Thailand ($100,000). There is a plan to submit an application for Phase II Transition To Scale funding to expand the CARE-Box provision to be more comprehensive and more broadly implemented.