Successful KNCV-led TB REACH-projects test Digital Adherence Technologies in the fight against TB

Since 2018, KNCV has rolled-out several Digital Adherence Technology (DAT) demonstration projects in countries such as the Philippines, Tanzania and Nigeria. These TB REACH projects were funded by the Stop TB Partnership. Goal of these demonstration projects was to assess the feasibility, acceptability by patients and health care providers, and the accuracy of digital adherence technologies.

In addition, the project assessed the overall impact of DATs on treatment outcomes and
general adherence behavior. As part of the project, KNCV will determine the necessary adaptations needed to make DATs suitable for a variety of contexts, including how to incorporate patient-centered mechanisms, and steps to scale-up and sustain these
innovative approaches.

TB REACH Tanzania

The TB REACH 99DOTS technology was implemented in the Geita region of Tanzania as a demonstration project with the aim to (i) implement 99DOTS adherence technology through NTLP service delivery and current work processes, systems and supply chains, (ii) build capacity within the NTLP regarding adherence technologies, (iii) assess practicalities, scalability, and impact on treatment outcomes of monitored self-administration and dose history informed differentiated care. Since the start of the project has provided critical learnings that have informed global adaptations to the Digital Adherence Technology (DAT) platform, reduced patients lost to follow up by 5% (compared with control facilities during the period of implementation), secured NTP and partner buy-in and have set the stage for the introduction of other types of digital adherence technologies – such as smart pill boxes – in Tanzania.

Read more in the project summary: TB REACH Tanzania

TB REACH The Philippines

The TB REACH project on treatment adherence aimed to:
– Implement 99DOTS adherence technology through National TB Program (NTP) accredited service delivery and supply chains, and
– Assess practicalities, scalability and impact on treatment outcomes of monitored self-administration and dose history informed differentiated care.

In 2019 we had the following successes:
– The treatment success rate was 79% (213/269) with 82 patients still undergoing treatment
– We secured buy-in of NTP (national, regional, local) and other stakeholders (e.g. WHO, private and public sectors)
– DAT is now included in the revised NTP Manual of Procedures
– We identified and proposed modifications needed in 99DOTS application and dashboard for enhancements in the KNCV-led ASCENT project (hyperlink)
– Participatory localization/customization of DAT and establishment of differentiation pathway of care – by regional and local stakeholders

Read more in the project summary: TB REACH Philippines and the patient story of Angelito from the Philippines.

TB REACH Nigeria

The KNCV-led TB REACH project, “Scaling up Innovative Delivery of TB Care to Nomadic
populations in northeastern Nigeria” was coordinated on the ground by two community-based organizations (CBOs) active in three states in northeastern Nigeria (Adamawa, Gombe and Taraba). KNCV provided technical and fiduciary guidance to the CBOs (Janna
Health Foundation and SUFABEL Community Development Initiative).

The purpose of this project was to expand TB care in an innovative and collaborative manner through involvement of nomadic leadership to ensure that patients and communities have ownership over the design, implementation and sustainability of the project, while retaining an evidence-based approach. The objective was also to stimulate policy change on the allocation of scarce resources to improve TB case detection.

The project was launched at the end of 2018. Community leaders, both male and female,
were engaged as TB advocates. A cadre of volunteers were recruited, and many were
provided with motorcycles to reach rural areas for screening and to transport sputum
specimens to TB laboratories. In 2019, nearly a half million nomads (men, women and
children) were actively engaged for TB screening.

In 2019, nearly 3,000 confirmed TB cases were diagnosed and put on appropriate treatment as a result of this project. In addition, as nomads are at greater risk for zoonotic TB due to drinking unpasteurized milk and exposure to animals with bovine TB, an operational research project was initiated by KNCV in collaboration with the CBOs and the
National TB & Leprosy Program, Nigeria.

Read more in the project summary: TB REACH Nigeria