XI. EVALUATION

The central question needing evaluation is "Can monitored SAT, focused counseling, selective DOT, and extensions in the duration of therapy achieve better overall results with less acquired drug resistance than a policy of DOT for all patients?" Initially, operational pilot studies will be needed to determine 1) the proportion of adherent patients who need only minimal attention, 2) the effectiveness of focused counseling carried out by caregivers and treatment supporters in improving adherence among poor compliers when directed to patients and families, 3) how many patients require selective DOT, 4) how many patients default and 5) the effectiveness of extending the duration of therapy when poor adherence occurs. Based on these pilot studies temporary guidelines for the proper mix of monitored SAT and DOT can be developed, followed by well-planned randomized controlled trials to develop optimal treatment strategies in multiple different settings.

XII. IN SUM

Universal DOT imposes significant burdens on both health departments and patients. At least sixty to sixty-five percent of patients are sufficiently reliable that they can be successfully treated with SAT. If further developed and reduced in cost by mass production, electronic medication monitors, could identify these reliable patients in most cases.  Management of less reliable patients would require focused counseling, selective DOT, retrieval of defaulters, and extensions in the duration of treatment. Such a medication monitor based program could lead to more satisfied patients, better use of limited resources, and better treatment outcomes.
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Acknowledgement.  The author wishes to acknowledge the significant contribution of Dr. Don Ellis at Spiderwort Design <spiderwort@pcisys.net> for advising on technical matters and collaborating in the development of medication monitor designs.
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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:

ELECTRONIC MEDICATION MONITORS HOME