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BMC Infect Dis. 2018 Apr 11;18(1):171. doi: 10.1186/s12879-018-3080-2.

Pilot evaluation of a second-generation electronic pill box for adherence to Bedaquiline and antiretroviral therapy in drug-resistant TB/HIV co-infected patients in KwaZulu-Natal, South Africa.

Author information

1
Columbia University College of Physicians and Surgeons, NY, NY, USA.
2
CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa.
3
McGill International TB Centre, McGill University, Montreal, Canada.
4
University of Michigan School of Public Health, Ann Arbor, MI, USA.
5
Yale School of Medicine, New Haven, CT, USA.
6
Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.
7
CAPRISA MRC- HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa. mo2130@columbia.edu.
8
Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, NY, NY, USA. mo2130@columbia.edu.
9
Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, NY, NY, USA. mo2130@columbia.edu.

Abstract

BACKGROUND:

The introduction of Bedaquiline, the first new antimycobacterial drug in over 40 years, has highlighted the critical importance of medication adherence in drug-resistant tuberculosis (DR-TB) treatment to prevent amplified drug-resistance and derive sustained benefit. Real-time electronic dose monitoring (EDM) accurately measures adherence and allows for titration of adherence support for anti-retroviral therapy (ART). The goal of this study was to evaluate the accuracy and acceptability of a next-generation electronic pillbox (Wisepill RT2000) for Bedaquiline-containing TB regimens.

METHODS:

Eligible patients were DR-TB/HIV co-infected adults hospitalized for the initiation of Bedaquiline-containing treatment regimens in KwaZulu-Natal, South Africa. A one-way crossover design was used to evaluate levels of adherence and patient acceptance of EDM. Each patient was given a Wisepill device which was filled with ART, Levofloxacin or Bedaquiline over three consecutive weeks. Medication adherence was measured using Wisepill counts, patient-reported seven-day recall, and weekly pill count. An open-ended qualitative questionnaire at the end of the study evaluated participant acceptability of the Wisepill device.

RESULTS:

We enrolled 21 DR-TB/HIV co-infected inpatients admitted for the initiation of Bedaquiline from August through September 2016. In aggregate patients were similarly adherent to Bedaquiline (100%) compared to Levofloxacin (100%) and ART (98.9%) by pill count. Wisepill was more sensitive (100%) compared to seven-day recall (0%) in detecting non-adherence events (p = 0.02). Patients reported positive experiences with Wisepill and expressed willingness to use the device during a full course of DR-TB treatment. There were no concerns about stigma, confidentiality, or remote monitoring.

CONCLUSION:

In this pilot study patients were highly adherent to Bedaquiline by all adherence measures. However, there was lower adherence to ART by pill count and Wisepill suggesting a possible challenge for adherence with ART. The use of EDM identified significantly more missed doses than seven-day recall. Wisepill was highly acceptable to DR-TB/HIV patients in South Africa, and is a promising modality to support and monitor medication adherence in complex treatment regimens.

KEYWORDS:

Bedaquiline; Drug-resistant tuberculosis; Electronic pillbox; HIV; Real-time monitoring

PMID:
29642874
PMCID:
PMC5896111
DOI:
10.1186/s12879-018-3080-2
[Indexed for MEDLINE]
Free PMC Article

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