Electronic Medication Monitors: Status of Development and Potential for Improving Effective TB Treatment Programs
Tom Moulding M.D.
Clinical Professor of Medicine
Harbor -UCLA Medical Center
214 Via La Soledad
Redondo Beach, CA 90277 USA
(310) 375 5980
Dr. Don Ellis
519 Pluto Drive
Colorado Springs, CO 80906 USA
(719) 447 0424
The purpose of this website is to present the status of development of a wide variety of portable electronic medication monitors that could be used to supervise the self-administered treatment of tuberculosis and perhaps AIDS. The discussion includes both commercially available devices and various designs of potential medication monitors, to allow investigators and funding sources to chose the optimal device for their needs and encourage inventors to develop improvements.
One company, Applied Minds, has in the past considered making these devices. The contact person is:
Dr. Danny Hillis
Applied Minds, Inc,
1209 Grand Central Avenue
Glendale, CA 91201 USA
Phone: (818) 545-1400
Fax: (818) 244-0204
SUMMARY OF JUSTIFICATION FOR USING MEDICATION MONITORS WHEN TREATING TB
WHO has strongly recommended Directly Observed Therapy (DOT) in the past. Recently, Wells et al surveyed the extent of DOT usage in High Burden Countries. (INT J TUBERC LUNG DIS 15(6):746–753) The answers were not always simple to interpret. However, they found that encounters with health care centers were often restricted to weekly, biweekly or monthly visits. In many HBCs, direct observation was primarily conducted by family (Indonesia, Kenya, Mozambique, Zimbabwe), self (Ethiopia, Nigeria, Russian Federation) or either family or self (China). The concept of self-DOT seems contradictory, but was reported because it was provided. This survey conclusively shows that DOT is not being widely used.
In contrast to previous recommendations which endorsed DOT for all patients, the current WHO stop TB strategy continues to stress supervised treatment but states it MAY need to include directly observed therapy (DOT) (WHO/HTM/STB/2006.37) This removes much of the burden that DOT imposes on both patients and treatment delivery systems. However, the new recommendations MAY lead to treatment failures and drug resistance because consistent accurate assessment of adherence is at best problematic. This emphasis on the word MAY points out the reason that a monitor is needed. Electronic medication monitors, devices that determine when medication is removed from a container, could significantly help overcome this problem even in poor developing countries. For extensive use in developing countries, monitors could be further refined and mass-produced to reduce cost. Both health facilities and community workers could dispense drugs for self-administered treatment (SAT) in medication monitors and retrieve the adherence record with computers and mobile phones when they are available or inexpensive built-in displays or audible tones when they are not available. These devices could keep the adherence record from the beginning of therapy for managing patients who move. Pharmacists using medication monitors could provide surveillance of SAT prescribed by private physicians with less adherent patients referred to health departments. Health departments could oversee Family Member DOT with these devices. Less adherent patients could be managed with focused counseling, DOT when necessary, and extensions in treatment duration. Removal of the DOT burden would encourage patients to seek free, high quality supervised pubic care and help expand effective TB treatment services. If the resources saved by giving less DOT were focused on less adherent patients and defaulters, medication monitor based programs should create less acquired drug resistance than programs that attempt but are overwhelmed by giving DOT to all patients.
For a more detailed discussion of these issues consult the following papers.
A Neglected Research Approach to Prevent Acquired Drug Resistance When Treating New Tuberculosis Patients (PDF)
Adapting to New International TB Treatment Standards with Medication Monitors and DOT given selectively
or contact Dr.Moulding at: firstname.lastname@example.org or Dr. Don Ellis at email@example.com
Adherence Monitors, Compliance Monitors, Medication Monitors, Tuberculosis Treatment, Directly Observed Therapy (DOT), Self Administered Therapy (SAT), Self Supervised Therapy (SST)