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
| dc.contributor.author | Bionghi, N | |
| dc.contributor.author | Daftary, A | |
| dc.contributor.author | Maharaj, B | |
| dc.contributor.author | Msibi, Z | |
| dc.contributor.author | Amico, K R | |
| dc.contributor.author | Friedland, G | |
| dc.contributor.author | Orrell, C | |
| dc.contributor.author | Padayatchi, N | |
| dc.contributor.author | O’Donnell, M R | |
| dc.date.accessioned | 2018-04-17T05:56:28Z | |
| dc.date.available | 2018-04-17T05:56:28Z | |
| dc.date.issued | 2018-04-11 | |
| dc.date.updated | 2018-04-15T03:18:09Z | |
| dc.description.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 Bedaquilinecontaining 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. | |
| dc.identifier.apacitation | Bionghi, N., Daftary, A., Maharaj, B., Msibi, Z., Amico, K. R., Friedland, G., ... (2018). 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. <i>BMC Infectious Diseases</i>, http://hdl.handle.net/11427/27787 | en_ZA |
| dc.identifier.chicagocitation | Bionghi, N, A Daftary, B Maharaj, Z Msibi, K R Amico, G Friedland, C Orrell, N Padayatchi, and "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." <i>BMC Infectious Diseases</i> (2018) http://hdl.handle.net/11427/27787 | en_ZA |
| dc.identifier.citation | Bionghi, N., Daftary, A., Maharaj, B., Msibi, Z., Amico, K. R., Friedland, G., ... & O’Donnell, M. R. (2018). 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. BMC Infectious Diseases, 18(1), 171. | |
| dc.identifier.ris | TY - Journal Article AU - Bionghi, N AU - Daftary, A AU - Maharaj, B AU - Msibi, Z AU - Amico, K R AU - Friedland, G AU - Orrell, C AU - Padayatchi, N AU - O’Donnell, M R AB - 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 Bedaquilinecontaining 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. DA - 2018-04-11 DB - OpenUCT DP - University of Cape Town J1 - BMC Infectious Diseases LK - https://open.uct.ac.za PB - University of Cape Town PY - 2018 T1 - 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 TI - 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 UR - http://hdl.handle.net/11427/27787 ER - | en_ZA |
| dc.identifier.uri | https://doi.org/10.1186/s12879-018-3080-2 | |
| dc.identifier.uri | http://hdl.handle.net/11427/27787 | |
| dc.identifier.vancouvercitation | Bionghi N, Daftary A, Maharaj B, Msibi Z, Amico KR, Friedland G, et al. 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. BMC Infectious Diseases. 2018; http://hdl.handle.net/11427/27787. | en_ZA |
| dc.language.iso | en | |
| dc.publisher | BioMed Central | |
| dc.publisher.department | Institute of Infectious Disease and Molecular Medicine | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights.holder | The Author(s). | |
| dc.source | BMC Infectious Diseases | |
| dc.source.uri | https://bmcinfectdis.biomedcentral.com/ | |
| dc.subject.other | Electronic pillbox | |
| dc.subject.other | Drug-resistant tuberculosis | |
| dc.subject.other | HIV | |
| dc.subject.other | Bedaquiline | |
| dc.subject.other | Real-time monitoring | |
| dc.title | 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 | |
| dc.type | Journal Article | |
| uct.type.filetype | Text | |
| uct.type.filetype | Image |