In March 2022, Richard Clores, the nurse who attends to drug-resistant tuberculosis (DRTB) patients at the Bulacan Medical Center PMDT satellite treatment center in Bulacan province, Philippines, enrolled five patients in the use of digital adherence technology (DAT) for their TB treatment. They are all participating in the ASCENT effectiveness study. Read below how nurse Clores enrolled the patients step by step.

TB Nurse Richard Clores (left) of Bulacan Medical Center in the Philippines, orients new patients on the drug-resistant tuberculosis treatment procedure they will undertake, its duration that may range from 4 to 24 months depending on the regimen, and the perseverance needed to complete it.

He also identifies the anti-TB medicines they need to take, describes their possible side effects, and outlines the steps the patients can do to address them. He underscores the potential outcomes of interrupting treatment and failing to take their medicines as prescribed.

Using the ASCENT-developed dosing instructions for DRTB, Nurse Clores identifies each anti-TB medicine and how many tablets a patient needs to take every day. He patiently answers the patient’s questions.

He gives all DRTB patients a plastic-laminated dosing instruction “placemat” on which the dose of each pill can be written. Every time the patients take their medication, they can refer to the dose of each tablet indicated on the placemat.

“You don’t need to visit the health facility every day for directly observed treatment (DOT) as practised before,” Nurse Clores tells the patients. DOT is still the standard worldwide that TB patients visit a health facility daily to take their medication so that healthcare workers can be sure that the patient is taking the medication correctly. He explains, “We’ll use digital adherence technology, DAT in short, that the KNCV-led ASCENT project makes available to us. DAT will enable you to digitally connect to the health center. While you take your medication at home, I will monitor your drug intake from my desk here in the facility.”

Nurse Clores elaborates, “For example, when you open the pillbox, your medication intake is recorded in the DAT system without your leaving your home. The system allows me to digitally ‘see’ that you took your pills for the day. This means you save on transportation money and travel time. Additionally, the pillbox does not require internet connection, which is an added benefit if network connectivity is unstable in your area.”

In the Philippines, ASCENT promotes the use of the Sure-Adhere app for video-supported treatment among DRTB patients and offers the smart pillbox by evriMED as an option.

A clear explanation of the purpose, benefits, and risks of participating in the ASCENT effectiveness study often encourages patients to get involved. The ongoing investigation on effectiveness seeks to determine whether DAT use and a differentiated response to patient adherence will reduce the number of patients with poor end-of-treatment outcomes compared with those receiving the standard TB care.

Above, Nurse Clores hands out the informed consent form the patients need to fill in to enroll in the study.

Each DRTB patient takes at least 12 different kinds of medication each day. Nurse Clores puts together the different pills that are generally enough for one month. When a patient visits the health facility for a refill, he’s ready to give them their supply of anti-TB drugs.

All pictures were taken by Jerelyn Ramos.

The Unitaid-funded and supported ASCENT project is led by KNCV Tuberculosis Foundation in partnership with The Aurum Institute, London School of Hygiene & Tropical Medicine, and PATH.