A large global study which aims to determine if digital adherence technologies can provide more patient-friendly approaches to improve tuberculosis (TB) treatment outcomes launches in Ethiopia, Tanzania, South Africa, the Philippines and Ukraine, as part of the ASCENT project.

The digital adherence technologies studied include medication labels and sleeves, smart pillboxes and video supported treatment that allow for remote communication between patients and healthcare centers.

These technologies respond to a key challenge in TB treatment: treatment is long and difficult to complete, lasting anywhere from six months to two years. Because of this, public health strategies have historically relied on Directly Observed Therapy (DOT), in which a clinician observes a patient taking their medicine each day to ensure adherence. These technologies aim to reduce or remove regular in-person visits required under the DOT model and enable healthcare workers to intervene only when necessary.

After COVID-19, TB is the deadliest infectious disease in the world, leading to 1.5 million deaths every year, despite being a curable disease.

The technologies are expected to improve experiences for TB patients and increase treatment completion rates by removing the heavy logistical, financial and time burdens that DOT places on both patients and health systems. Additionally, removing the need for DOT would make TB care significantly more efficient and represent huge savings to public health programmes.

The main research phase, now launched in all countries, evaluates three digital adherence technologies:

• Smart pillboxes that send a message to the clinic every time the patient opens it up to take their medicine.
• Medication labels or sleeves that help patients to send a code via SMS  to the clinic every time they take their dose.
• A video application that helps patients film themselves taking their medicine, and then securely sends the video to the clinic.

Wide reaching applications

ASCENT aims to enroll thousands of TB patients by the end of 2022. If proven effective, these tools could have wide-reaching applications to support patients undergoing treatment for any disease which requires them to take medication over an extended period.

“Practical, patient-centered solutions are essential in developing public health strategies that work. Digital adherence technologies are designed to support people in taking their medication while providing information that helps healthcare workers give more tailored care. These innovations, when coupled with advances in treatment and prevention, could modernize and accelerate global efforts against TB” says Janet Ginnard, Director of Strategy at Unitaid, global health agency and funder of the ASCENT project.

Research phase

ASCENT facilitates adoption and uptake of DATs in the five project countries in partnership with the national TB programs. The research component generates evidence for the proper use and scale-up of these innovations. The results are expected to offer guidance to the World Health Organization (WHO) and national TB programs.

“We are trying to effectively evaluate whether health facilities that utilize DATs do better in terms of treatment outcomes than facilities that do not and why. We are also focused on understanding the acceptability of DAT and the social and financial benefits to both the patients and the health facilities” says Jens Levy, KNCV’s chief researcher of the ASCENT project.

In the Philippines, Ukraine, Tanzania and South Africa treatment outcomes will be reviewed during the six months of treatment. In Ethiopia the study includes a six-month follow-up beyond treatment to see if there is recurrence of TB. Study protocols are nearly identical in each country, allowing researchers to evaluate the effectiveness of DATs in a variety of healthcare settings and circumstances.

TB policy

“For everyone working with these interventions and for those who want to in the future, scientific evidence is crucial. We are honored to lead this research. Contributing to the fight against TB in a patient friendly way”, says Mustapha Gidado, executive director of KNCV Tuberculosis Foundation.

Co-investigator of the overall project and chief investigator for the Ethiopian study, Katherine Fielding from LSHTM, says about the ASCENT project: “If it’s shown to be a successful intervention, that could be very beneficial for worldwide TB programs. This might change policy of TB treatment across the world”. Read more about the ASCENT research in this interview.

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