V. EXPERIENCE WITH SELF ADMINISTERED TREATMENT GIVEN IN MEDICATION MONITORS (MONITORED SAT)

Among 122 patients in the United States taking mainly isoniazid (INH) and para amino salicylic acid (PAS) as self administered treatment from non-electronic medication monitors, (monitored SAT) for 18 to 24 months, 82.3% took 70% or more of their prescribed medication and 60.7% took more than 90% of their medication. (Moulding et al. 1970) Homeless and alcoholic patients were not included in the study.  Among 106 patients in Haiti taking a combined preparation of INH and thiacetazone from non-electronic medication monitors for one year who received counseling based on the monitor record (focused counseling) 79.5% took >80% of their medication. Focused counseling reduced defaulting by 45%. (Moulding and Caymittes 2002) These data demonstrate that there are reliable patients who can be treated with SAT and less reliable patients who require additional measures to ensure adherence.

A study of adherence to latent tuberculosis treatment with 104 patients in Canada using electronic medication monitors found that therapy completion was closely associated with the percent of doses taken in the first month of treatment. (P<.0001. (Menzies et al. 2005)  The study also found that patients who took medication nearer the same point in time each day were more likely to complete treatment. This was determined by the variability of the interval between doses (in hours). (P = .003) The accuracy of prediction improved when both indicators were considered together. (P<.0001) Since these latent TB patients were not sick, these findings may or may not be applicable to patients with active TB who are usually motivated to take treatment initially when they are ill. However, the monitor study in Haiti with patients who were sick with TB showed that patients with > 90% adherence in the first 11 weeks were approximately three times more likely to have good adherence during one year of treatment (p< 0.01), and six times less likely to default (p< 0.01).  (Moulding and Caymittes 2002). While these studies suggest that an early monitor record helps predict later adherence and defaulting, additional confirmatory studies are clearly needed.
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SUMMARY

I. INTRODUCTION

II. THE SUCCESS AND PROBLEMS WITH DOT

III. RELIABLE PATIENTS - A POTENTIAL RESOURCE FOR REDUCING THE ADHERENCE PROBLEM

IV. DETERMINING THE ADHERENCE OF PATIENTS

V. EXPERIENCE WITH SELF ADMINISTERED TREATMENT GIVEN IN MEDICATION MONITORS (MONITORED SAT)

VI. PROPOSED SUPERVISION OF TREATMENT BASED ON MONITORED SAT AND DOT GIVEN SELECTIVELY

VII. USE OF MONITORED SAT TO IMPROVE TREATMENT OUTCOMES AND EXPAND SERVICES IN VARIOUS SETTINGS

VIII. CAN MEDICATION MONITORS HELP PREVENT DRUG RESISTANT DISEASE

IX) USE OF MEDICATION MONITORS WHEN MANAGING HIV/AIDS and HIV/AIDS/TB

X) EXPENSE AND PRACTICALITY OF USING MEDICATION MONITORS

XI. EVALUATION

XII. IN SUM

REFERENCES:

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