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

Treatment of HIV/AIDS with anti-retroviral drugs poses even greater adherence problems, since the patient must take anti-retroviral therapy for life. However, if inexpensive medication monitors and focused counseling improved treatment results by as little as 10%, a case could be made that medication monitors should be used, since anti-retroviral drugs are relatively expensive and decreases in the viral load have been shown with improved adherence. (Paterson et al. 2000)

X) EXPENSE AND PRACTICALITY OF USING MEDICATION MONITORS

While doctors, nurses, pharmacologists, bacteriologists, drug companies, and clinical trial experts have all contributed partial solutions to the adherence problem, it remains a major obstacle to effective TB control. Therefore, is it not time to enlist the expertise of an additional discipline, engineers, who could use modern inexpensive electronic technology to help solve this persistent serious problem?

In developed countries the cost of medication monitors should not inhibit their usage. For developing countries, the expense may at first glance appear unrealistically excessive. However, manufacturing costs in large volume production in low wage countries are estimated to vary between  <$5.00 and <$10.00 per device. (Personal Communication Dr. Daniel Hillis –Applied Minds Inc. 2006)  The ultimate cost per patient treated should be lower, since the equipment could be reused for numerous patients until it is lost or broken. To place these costs in perspective, WHO estimates that in high burden countries median costs for first line drugs are $26.00, and total costs for each new patient is $259.00 (WHO 2007) If using medication monitors leads to more efficient use of program resources, greater acceptance of treatment by patients, and better treatment results, the additional cost for medication monitors could be readily justified.
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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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