The Impact of Digital Adherence Technologies on Health Outcomes in Tuberculosis: A Systematic Review and Meta-Analysis
Notice bibliographique
Résumé
Abstract Background Suboptimal tuberculosis (TB) treatment adherence may lead to unsuccessful treatment and relapse. Digital adherence technologies (DATs) may allow more person-centric approaches for supporting treatment. We conducted a systematic review (PROSPERO-CRD42022313166) to evaluate the impact of DATs on health outcomes in TB. Methods We searched MEDLINE, Embase, CENTRAL, CINAHL, Web of Science and preprints from medRxiv, Europe PMC, and clinicaltrials.gov for relevant literature from January 2000 to April 2023. We considered experimental or cohort studies reporting quantitative comparisons of clinical outcomes between a DAT and the standard of care in each setting. Results Seventy studies (total 58,950 participants) met inclusion criteria. They reported SMS-based interventions (k=18 studies), feature phone-based interventions (k=7), medication sleeves with phone calls (branded as “99DOTS,” k=5), video-observed therapy (VOT; k=17), smartphone-based interventions (k=5), digital pillboxes (k=18), ingestible sensors (k=1), and interventions combining 2 DATs (k=1). Overall, the use of DATs was associated with more frequent treatment success in TB disease (OR = 1.18 [1.06, 1.33]; I 2 = 66%, k = 46), a decrease in loss to follow up (OR = 0.71 [0.53, 0.94]; I 2 = 80%, k = 36) and an increase in adverse event reporting (OR = 1.53 [1.26, 1.86]; I 2 = 0%, k = 9). VOT was associated with an increased likelihood of treatment success in TB disease (OR 1.54 [1.09; 2.19]; I 2 = 0%, k = 8) and treatment completion in TB infection (OR 4.69 [2.08; 10.55]; I 2 = 0%, k = 2) as well as an increased frequency of adverse event reporting (OR = 1.79 [1.27; 2.52]; I 2 = 34%, k = 4). Other interventions involving smartphone technologies were associated with increased treatment success in TB disease (OR 1.98 [1.07; 3.65]; I 2 =56%, k = 5) and a decreased frequency of loss to follow up (OR = 0.31 [0.13; 0.77]; I 2 = 36%, k = 5). Digital pillboxes were also associated with an improvement in treatment success (OR = 1.32 [1.00; 1.73]; I 2 = 71%, k = 11). However, improved treatment success was only seen in high- and upper middle-income countries. SMS-based interventions, feature-phone interventions and 99DOTS were not associated with improvements in short-term clinical outcomes. Conclusion Certain DATs--notably VOT and smartphone-based interventions, in higher income settings and sometimes combined with other supportive measures—may be associated with improvements in treatment success and losses to follow-up, compared to standard care. However, evidence remains highly variable, and generalizability limited. Higher quality data are needed.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,015 | 0,005 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».