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The Unitaid-funded ASCENT project, which stands for Adherence Support Coalition to End TB, aims to improve treatment outcomes through affordable digital adherence technologies.

Approximately 10 million people fall ill each year with tuberculosis (TB), with an estimated 1.6 million people dying from the disease in 2017 alone. This is unnecessary for TB can be cured using the appropriate medication for 6 months or longer, depending on the type of TB. Non-adherence to treatment is a major barrier that patients and national health programmes face in the fight against TB, leading to relapse, drug-resistance, disease transmission and health system costs.

Problem statement

Rethinking optimal care for TB patients

Historically, the most widely-implemented means of supporting TB patients and ensuring adherence for their treatment is Directly Observed Treatment (DOT). With DOT, a healthcare worker observes (in-person) the patient’s daily ingestion of medication, either at the healthcare facility or patient’s home. The DOT approach has advanced global decline in TB incidence. However innovations are needed to address existing gaps, enable system efficiencies, improve patient-centered care, empower providers and patients and achieve greater impact for all types of TB.

By taking advantage of today’s powerful communication mechanisms, the implementation of digital adherence technologies (DAT) can help to overcome health care disparities by allowing patients greater freedom to self-manage and participate in their own care. DAT can also contribute to the reduction of financial burdens and restore autonomy and dignity, and simultaneously empower providers with accurate and timely information to provide differentiated care. The implementation of DAT has therefore the potential to be a major step forward in this regard. By utilizing an integrated platform of mobile phone, computer, and electronic sensor technology to capture detailed adherence data, we can develop patient specific algorithms. This will enable both improved individual outcomes and greater impact of TB treatment approaches worldwide.

The ASCENT project (July 2019 – Dec 2022) will build on existing evidence, innovations in adherence technology and growing global momentum to implement integrated DAT interventions in five key countries (Ethiopia, the Philippines, South Africa, Tanzania, and Ukraine) for all types of TB (DS-TB, DR-TB, LTBI). Comprised of four key outputs, the ASCENT project will operationalize a DAT intervention in diverse geographic, cultural, and infrastructural settings.