POTENTIAL AND EXISTING MEDICATION MONITOR DESIGNS
WHO's stop TB strategy stresses the use of supervised treatment which may need to include directly observed therapy (DOT). The supervision of treatment can be carried out by a treatment supporter, who is acceptable to the patient and trained and supervised by health services. (WHO/HTM/STB/2006.37)
While certainly appropriate and more reasonable than DOT for everyone, this recommendation could result in treatment failure if the patient was not on DOT and the treatment supporter failed to recognize that the patient was not taking the medication as prescribed.
Medication monitors, devices that determine when patients remove medication from a container, could improve results with this recommendation by providing the patients' adherence records to the patient and treatment supporters. This should help motivate the patient and greatly increase the effectiveness of the treatment supporters by allowing them to 1) give more intensive counseling to the less adherent patients and their families, 2) provide DOT when necessary, and 3) extend the duration of therapy based on the monitor adherence record.
There are multiple ways that Medication Monitors (adherence monitors) could be constructed. When deciding on which is the optimal design, factors such as 1) protection of the medications against moisture, 2) number of different items in the supply lines and clinic inventories, and 3) the ease of refilling the device need to be considered.
For the initial two months of TB therapy a four-drug combination tablet, which includes a hygroscopic medication Ethambutol, is usually given. Ethambutol is sometimes used in the later months of therapy. Consequently, protection against ambient moisture reaching the medication will be needed for many TB regimens. Ambient moisture protection probably won't be needed for drugs used to treat HIV/AIDS.
In all but one of the devices described in this material, the medication is placed in multiple cavities. While it might be possible to place a moisture proof cover over the cavities after they are filled in a clinic, it is doubtful if adequate moisture protection would be created if the clinic did not have electricity to create a heat seal.
Consequently, achievement of adequate moisture protection will probably require that the medication be placed in moisture proof packages in a factory. Since the number of pills given each day for TB varies from 2 to 5 according to the patient's weight, factory packaging could potentially increase the number of different items in the supply lines and clinic inventories 4 fold, i.e. for each medication there would need to packages containing 2,3,4, and 5 pills. The clip monitor, stack monitor, and strip package monitor were designed to overcome this problem.
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POTENTIAL AND EXISTING MEDICATION MONITOR DESIGNS
I. Cover and Cap Opening Monitors
II. Dose Removal Monitors