ArticleBMC public health2023
Risk factors for poor engagement with a smart pillbox adherence intervention among persons on tuberculosis treatment in Ethiopia.
Article in BMC public health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed, 13 citations in OpenAlex.
- Baseline determinants of adherence for drug-sensitive TB treatment in a South African prospective cohort: a focus on HIV infection and anti-retroviral therapy, clinical care access, and TB stigma.BMC infectious diseases · 2026Trial
- Pillbox and patient-oriented manual interventions to improve medication knowledge, attitudes, and practices among older adults with multimorbidity in Shanghai, China.BMC geriatrics · 2026Article
- Article
- Time to first and recurrent missed video directly observed therapy sessions and associated factors among people with Tuberculosis in Kampala, Uganda.Frontiers in digital health · 2026Article
- Enhancing tuberculosis care in lower and middle-income countries through digital adherence technologies.Breathe (Sheffield, England) · 2026Article
- TB-Related Stigma: A Hidden Obstacle to Adherence Monitoring with Video Directly Observed Treatment Among Patients with Tuberculosis in Uganda.Research square · 2025Article
- Process Evaluation of Pragmatic Cluster-Randomized Trials of Digital Adherence Technologies for Tuberculosis Treatment Support: A Mixed-Method Study in Five Countries.Tropical medicine and infectious disease · 2025Article
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Authors and funding
15 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundNon-adherence to tuberculosis treatment increases the risk of poor treatment outcomes. Digital adherence technologies (DATs), including the smart pillbox (EvriMED), aim to improve treatment adherence and are being widely evaluated. As part of the Adherence Support Coalition to End TB (ASCENT) project we analysed data from a cluster-randomised trial of DATs and differentiated care in Ethiopia to examine individual-factors for poor engagement with the smart pillbox.
methodsData were obtained from a cohort of trial participants with drug-sensitive tuberculosis (DS-TB) whose treatment started between 1 December 2020 and 1 May 2022, and who were using the smart pillbox. Poor engagement with the pillbox was defined as (i) > 20% days with no digital confirmation and (ii) the count of days with no digital confirmation, and calculated over a two evaluation periods (56-days and 168-days). Logistic random effects regression was used to model > 20% days with no digital confirmation and negative binomial random effects regression to model counts of days with no digital confirmation, both accounting for clustering of individuals at the facility-level.
resultsAmong 1262 participants, 10.8% (133/1262) over 56-days and 15.8% (200/1262) over 168-days had > 20% days with no digital confirmation. The odds of poor engagement was less among participants in the higher stratum of socio-economic position (SEP) over 56-days. Overall, 4,689/67,315 expected doses over 56-days and 18,042/199,133 expected doses over 168-days were not digitally confirmed. Compared to participants in the poorest SEP stratum, participants in the wealthiest stratum had lower rates of days not digitally confirmed over 168-days (adjusted rate ratio [RR
conclusionPoorest SEP stratum, HIV-positive status, single/living independent and separated/ widowed were associated with poor engagement with smart pillbox among people with DS-TB in Ethiopia. Differentiated care for these sub-groups may reduce risk of non-adherence to TB treatment.
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