Project: "Digital Health Adherence in Ukraine"
To explore practical aspects of using DATs in the local context in Ukraine, the W6 TB REACH project, implemented by PATH, with LHSI acting as a Sub-contractor in consortium with KNCV, and Everwell. The project piloted the use of digital health solution, namely real-time electronic dose monitors, in out-patient models of TB treatment, including DR-TB, from October 2018 to December 2019 in high TB burden oblasts in southern Ukraine (Odeska and Mykolaivska oblasts) both with high levels of HIV co-infection (45% and 29%, respectively). The project used evriMED devices - medication reminder and digital remote treatment adherence monitoring devices, also called ‘smartboxes’. The 99DOTS platform (Android app) was used to monitor the information sent by smartbox, which captured the medication uptake by the patient. The use of another DAT - Sureadhere VDOT - was also piloted as a part of project efforts. There is a potential of using Sureadhere for video DOT and other apps in Ukraine. Project providers reported a high use of their smart phones when monitoring patients’ drug intake.
The use of DATs followed Standard Operational Procedures (SOPs) to monitor TB patients’ treatment at the regional level. The proposed strategy is solely tied to outpatient care and could be applied for every patient who is not hospitalized at the moment of service provision. The process was integrated into current NTP processes, systems, and supply chains, coupled with patient-centered services already being provided through other efforts.
Results: From a total of 1712 TB patients on treatment in project sites, 902 (53%) patients on treatment in regional TB facilities were enrolled on smartbox evriMED devices in project sites. [Mean age of the registered TB patients was 43 years with predominance of “new cases” (n = 647 , 71%) and “male” gender (n = 585, 63,9%). In addition, proportion of PLHIV among registered TB cases is 46,8% in Odeska and 28% in Mykolaivska oblasts. 708 MDR-TB cases started on treatment in Odeska oblast and 275 – in Mykolaivska.
The implementation research was carried out by LHSI using StopTBPartnership methodology. The report is available to find out more about Acceptability and Feasibility of Digital Adherence Technology (DAT) in TB REACH project in Ukraine.