Digital adherence technologies (DATs) are increasingly used around the world in a variety of income settings to assist patients diagnosed with tuberculosis (TB) in adhering to medication regimens. This emerging market is an exciting development within the global health field and of interest to a wide range of stakeholders but currently not well understood and quantified. Through the process of market sizing, the ASCENT project aims to analyze and communicate key trends and opportunities in the global DATs in the TB treatment market.
Note: This work only explores potential use of DAT for one health condition – infection with TB. Other use cases for DAT are well-established and would increase the overall DAT market size but remain outside the scope of this analysis.
The global DAT for TB market is nascent, with high potential for future growth.
- Few existing DAT products are explicitly designed to target users in middle-or-low-income markets to support treatment of infectious diseases. For TB, demand for DAT is growing, with still approximately 9 million infections occurring annually worldwide.
- Demand for DAT for TB will likely be highest in Asia and Africa, regions where TB incidence are highest. This geographic distribution may benefit existing manufacturers in South Africa and India, and encourage further innovation leading to locally adapted products.
However, growth of the DAT for TB market may be fragmented, favoring high burden countries with well developed health and information technology systems.
- At the country level, sustained market growth requires a large market size in the near term that is serviceable by DAT. The market conditions in Asia, combining high TB burden combines with generally well-developed diagnostic and telecommunication systems, is particularly conducive to growth.
- While potential demand is high in the Africa region, overlapping challenges (ex: lower diagnosed TB burden, sub-optimal telecommunication network coverage, low rates of cellular phone ownership and urbanization, etc…) depress the market size which can be serviced in the near term. Low market opportunity may discourage potential domestic manufacturers and disincentive market entry by foreign manufacturers. Global mechanisms and support for procurement and adoption of DAT may be needed to establish and sustain markets.
In countries where TB care-seeking in the private sector is high, integration of DATs into routine TB case management will require extensive public-private collaboration.
- The roadmap for DAT adoption at the country level is clearest in contexts where the public sector is dominant. The effort required to engage and incentive adoption in private sector, which in LMICs can encompass a dizzying variety of independent care providers, will likely be substantial.
- Ongoing implementation pilots, such as in the ASCENT project, will illuminate the roadmap and barriers to widespread adoption. Many high-burden countries where private sector utilization is high (particularly in South-East Asia) have already begun to adopt DAT at a limited scale in the private sector.
DAT that require less information and communication technology access for use (for example feature phone instead of smart phone) are better suited for widespread use in the global DAT for TB market.
- Middle-or-low-income markets with the highest need for DATs for TB treatment tend to have considerably more feature phone users than smart phone users. Additionally, access to 3G+ cellular networks tend to be low in rural areas.
- There is still a market for smart phone based DATs in high-income countries and urban areas in middle-or-low-income markets, to meet user preferences. Ultimately, countries will likely adopt multiple types of DAT products within an interoperable environment, creating market opportunities for a diversity of DAT manufacturers.
- In most country markets, the cost to use SMS is relatively affordable. This suggests that usage costs is unlikely to be a major barrier to adoption of SMS-based DAT in most contexts.