PATH collaborates with ASCENT to support patient-centered TB care

PATH is embarking on a collaboration with ASCENT, a partnership led by KNCV Tuberculosis Foundation and funded and supported by Unitaid, to help patients in five countries in Asia, Africa, and Europe adhere to and successfully complete TB treatment using digital technology. PATH’s role is leading the implementation and evaluation of digital adherence technologies in Ukraine beginning in 2020. Our Market Dynamics team is collaborating with partners across the consortium to establish a global market for optimized products, price, and supply chain models.

The End TB Strategy states that, “Ending the tuberculosis epidemic will require further expansion of the scope and reach of interventions for tuberculosis care and prevention.” Digital adherence technologies provide an opportunity to meet the wide-ranging needs of TB patients through a differentiated care model. This type of approach acknowledges that different patients require different levels of care. Under ASCENT in Ukraine, PATH is implementing the use of two types of digital adherence technologies:

• video supported treatment where a patient records a video on their mobile phone during medication intake and sends the video message to a health care worker
• smart pill box to store TB medication that is designed with a small-scale, battery-powered sensor, and mobile data connection. When the patient opens the box, it sends a signal to the health care worker. When the box is not opened, the health care worker contacts the patient to follow up

The implementation of these interventions positions Ukraine as an early adopter of these technologies. PATH and the ASCENT team anticipate the findings from this project will inform a digital adherence implementation model to be adopted by other participating countries.

For the market-related activities, PATH is working closely with KNCV and the other consortium partners, The Aurum Institute, and London School of Hygiene & Tropical Medicine, to ensure the market is primed for digital adherence technologies and that the anticipated global growth in demand that results from increased implementation, utilization, and stakeholder engagement activities, including with manufacturers and global procurement mechanisms, that are strengthened under the ASCENT scope of work, can be met.

Our experience developing and promoting digital adherence technologies

PATH has been promoting the use of digital adherence technologies to reduce TB incidence, mortality, and financial consequences since 2009, with pilot projects that began in China, which has the second highest number of TB cases in the world and represents 9% of the global TB burden and 14% of the drug-resistant TB burden. In partnership with the government of China and with support from the Bill & Melinda Gates Foundation, over the last ten years PATH has conducted a range of studies on feasibility, effectiveness, operational research, and cost-effectiveness. In India, PATH has implemented the use of smart pill boxes and medication sleeves, similar to those under ASCENT, in which patients receive their TB medication in customized blister packages that describe dosage instructions, including a hidden phone number behind the pills. PATH is currently working with the government of India to inform the development of the guidelines and support the national scale-up of digital adherence technologies.

Successfully completing treatment for people with TB disease remains a challenge for many reasons. Treatment regimens can range from six months to two years. Some patients may stop taking TB medications once they begin to feel better even if they have not completed their treatment and fall ill again, which contributes to bacteria developing resistance to TB drugs. Additionally, directly observed treatment, where a health care worker observes in person a patient taking medication, has been the recommended approach and implemented widely. However, this practice is often not feasible for patients who may face a range of barriers accessing health facilities, whether geographic when distance is a challenge or financial when there is loss of income due to missed work. Inconsistent treatment adherence has negative effects for patients and is detrimental to the global effort to end the TB epidemic.

The ASCENT project is made possible thanks to Unitaid’s funding and support. Unitaid accelerates access to innovative health products and lays the foundations for their scale-up by countries and partners.