Abstract
Thailand is one of the 14 listed countries encountering TB, TB/HIV and MDR-TB burden. Poor adherence could cause longer treatment, drug resistance, relapse and death in TB patients. With limited-resources, the coverage of Directly Observed Treatment, Short Course (DOTS) is low. Most of TB patients are under self-medication or family-member DOT, which a forgetfulness to take medicine or an improperly early medicine discontinuation caused by side effects or etiological misunderstanding may exist. Most of adherence measurements performed at a next follow-up, not at real-time, is considered as an end point. Hence, TB/HIV Research Foundation has developed a CARE-call system, an ICT-based medication adherence monitoring system having an electronic pill box (CARE-box) to further function by alarming patients to take medicine, notifying a health care worker (HCW) to follow up a non-adherence patients and providing two-way communication for the patients seeking for advice from the HCW. In order to evaluate the system’s effectiveness, 300 TB patients were randomly recruited into intervention or control group. Preliminary result obtained from treatment-outcome available participants showed that statistically higher adherence rate was observed in the intervention group while treatment success rate is at 88.2%, higher than the 85% NTP target and lost to follow-up cases were found only in the control group. The CARE-call system was proved to achieve its two-way communication function under around four-time lower per capita cost compared to that of the DOT supported by the global fund. Qualitative study remarked the benefits of CARE-call system through the CARE-box including alarming system, daily pack, two-way communication by meeting the satisfactions of the all the participants invited to attend focus group discussion. From the result, it is believed that the CARE-call system could improve the TB patient’s medication adherence and provide two-way communication at low cost, which is more suitable for a high TB burden country like Thailand to achieve the NTP targets for treatment success and loss to follow-up rates. However, the stability of CARE-call should be improved and provide more useful functions to facilitate the TB treatment and care.
