The City of Cape Town’s Health Department is excited to be part of a project to test the efficacy of a new treatment monitoring system for patients with drug-resistant Tuberculosis (TB).

The project is a collaboration between City Health, the Aurum Health Institute, which is part of the ASCENT (Adherence Support Coalition to End TB) consortium and TB HIV Care (THC), which is funded by the Global Fund via the National Department of Health.

TB continues to be one of the biggest health challenges in South Africa, particularly as it relates to supporting adherence to treatment regimens.

Drug-resistant TB requires the administration of medication daily for anywhere between nine and 20 months. Erratic treatment adherence could potentially have unfavourable consequences, which may result in prolonged treatment, resistance to medication, the spread of disease and even death.

In recent years, there have been significant changes in the treatment offered to patients with drug-resistant TB, with the introduction of new drugs and shorter, injection-free regimens.
In spite of these policy changes, this has not significantly improved retention in care, due to many factors such as the long duration of treatment, high medication burden, frequent side effects, socio-economic factors, substance use, and mental health issues among others.
“In addition, the health system simply does not have the human resources to support across the board, so this new project, which is essentially an electronic pillbox, will allow far easier monitoring, and providing support to patients to stay the course.”

“These pillboxes can provide reminders for patients to take their medication, and provide real time updates into a back-end server on when the pillbox was opened. Additionally, they can generate digital adherence reports that can be shared with clinicians. This can be used to identify early adherence challenges and provides an opportunity for clinicians to respond appropriately with additional support to clients,” said the City’s Mayoral Committee Member for Community Services and Health, Councillor Zahid Badroodien.

Since the beginning of August, nearly 60 drug-resistant TB patients have been enrolled onto the project, with an average of 84% adherence in City of Cape Town facilities that have started implementing it.

“Staff are quickly able to identify patients who have missed doses and are able to provide additional adherence support to encourage them to return to care and to address the barriers to treatment. Improving adherence to treatment will improve outcomes and contribute to reducing disease transmission in our communities. We expect to enrol more than 600 DR-TB patients over the next year onto this project.  The project will compare the treatment outcomes in these patients with previous patients to determine whether this is an intervention that may be implemented to scale in the coming years,” added Councillor Badroodien.

The Aurum Health Institute will provide strategic project direction based on their experience in implementing similar projects, and will lead research operations and undertake a project evaluation as well as provide technical support.

TB HIV Care, funded through the Global Fund, will procure the electronic medication monitors from the service provider and will support training and implementation, ongoing site support and deploy two roving social workers who will conduct psychosocial assessments on all patients.

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