U of T Researchers Receive Grant to Increase Tuberculosis Treatment Adherence in Tibet

August 23/2018

By Françoise Makanda, Communications Officer at the Dalla Lana School of Public Health

People living in two of Tibet’s remote communities will receive much-needed tuberculosis treatment support in a new trial led by DLSPH researchers.

A grant from Stop TB Partnership will allow Xiaolin Wei and his team to deliver a novel treatment adherence program through WeChat — an instant messaging app widely used in Asia — for tuberculosis patients in two districts of Shigatse, Tibet, in collaboration with Dr. Jun Hu from Shigatse Centre for Disease Control and Prevention.

“With this grant, our goal is to improve tuberculosis treatment outcomes through enhanced health provider communication in Shigatse,” said Wei, an Associate Professor at DLSPH and the Secretary-General of the International Union Against Tuberculosis and Lung Disease.

“We chose WeChat because it is widely used and we know that if you have a new app, patients might not use it.”

According to the World Health Organization (WHO), tuberculosis is one of the top ten causes of death worldwide. Treatment is less forgiving if adherence is poor or irregular, which is why directly observed therapy (DOT) has been the core of WHO’s tuberculosis program. However, DOT is time consuming, costly, and may impose extra travel time and stigma for patients. The grant will support a new treatment adherence intervention with directly monitored self-administered treatment through WeChat.

This intervention is desperately needed in areas like Shigatse, which is located 4,000 meters above sea level with a density of three people per kilometre. Villages in this area are so remote that it’s physically and financially challenging to access.

An electronic box advises doctors and their supporters when the patient has taken the treatment. When the box is opened, doctors and supporters are aware that the patient has taken a treatment. The healthcare team will contact patients who have missed a dosage and will request photos or videos of the patient taking the treatment for three days to ensure adherence to the treatment program.  Through the project, the team will follow up with patients through voice notes, and health education messages to monitor treatment side effects, such as rashes.

The research team will send treatment reminders and doctor visit alerts to the patient’s WeChat account.  The patient’s health care team will have access to similar information, which will reduce the number of physical appointments with healthcare workers.

“The communication is not in a group; it is very channel specific. As a patient, I only talk to my doctor or my treatment supporter. As a treatment supporter, you’re only going to see your patient to protect his/her privacy. Supporters, in turn, can follow up with patients who missed their medications,” said Wei, underlining the project’s built-in features to ensure patient privacy.

Researchers will measure their efforts through a randomized control trial.

Wei says that tuberculosis is still stigmatizing but hopes that the project can be expanded to other regions of the world. For now, he is eager to build clinical public health research capacity in Shigatse.

“This trial will provide much-needed evidence on tuberculosis treatment adherence to support recommendations for policy and practice change. It will also train research associates based in Tibet and build research capacity with local health care providers who will be involved in data collection and patient care.”

The Stop TB Partnership administered the grant with a financial commitment from Global Affairs Canada and additional funding from the Bill and Melinda Gates Foundation.

Too long; didn’t read? Watch the video below