Interactive booklet and pillboxes improve DR-TB treatment adherence

The treatment of Drug- Resistant TB (DR-TB) treatment has rapidly evolved over the last five years with the first new oral DR-TB drug, Bedaquiline, being introduced into the NDOH DR-TB programme in 2017. Following the successful introduction of Bedaquiline into a nine-month all-oral regimen, all treatments for DR-TB in South Africa were transitioned into injection (Kanamycin)- free regimens in 2018.

Despite these advances, the treatment regimens for DR-TB remain complex, with patients requiring seven different drugs (up to 17 tablets daily) on the nine-month short regimen; and at least five different drugs (up to 12 tablets daily) on the 18-month long course regimen. In addition to the numerous tablets that need to be taken for prolonged periods, the dosing schedule for Bedaquiline is complex: four tablets need to be taken daily for two weeks, followed by two tablets taken three times a week.

In order to support the advances made in DR-TB treatment and to improve successful treatment outcomes, the USAID TB LON-SAFT Programme’s technical team developed an Adherence Information Booklet to be used in conjunction with jumbo-sized pillboxes, which were also procured.

In the booklet the treatment regimen and treatment journey are shown in detail, as well as the complicated dosing schedule for Bedaquiline.

A progress chart encourages the patients to complete their treatment. Information on potential side effects, storage of medication, infection control and household contact tracing are also included.

The booklet was specifically designed to cater for both literate and illiterate people by including visual illustrations as communication tools. Different booklets have been developed for the short-course regimen as well as the long-course regimen. These are available in both English and isiZulu.

The counsellors provide counselling using the Adherence Information Booklet as well as assist patients with the packing of their pillboxes, while providing education on the DR-TB treatment. The response from the patients and healthcare workers has been very positive.

Quote from Adherence Counsellor:

“I have had a wonderful experience using the Adherence Booklet. The pictures tell a story that most of our patients understand. It starts with their first hospital visit and follows the journey until they are discharged. It also explains things that they need to practice at home. Patients who are going to be discharged always confirm that they want to get their pillboxes. I have also realized that it is a weight off their shoulders that we pack their pillboxes with them, and this is something they really appreciate.”

The USAID TB LON – SAFT adherence counsellors have provided enhanced counselling to all 128 newly initiated DR-TB patients since the implementation of the programme in March 2020.   All patients reached since March 2020 were issued with Adherence Booklets and pillboxes. Those that had initiated treatment before the implementation of Brochures and pillboxes were issued these at follow up visits, while all patients that initiated treatment from September were given these at treatment initiation. While the impact of these has therefore yet to be assessed, feedback from patients and healthcare workers has been extremely positive.

Quotes from patients:

“The booklet saved me because my daughter is 14 years old and I don’t always get to take time out and come to the hospital with her but the booklet helped me understand the do’s and don’ts of MDR-TB. It even helped the house helper so everyone knows how to handle it.”

“I don’t think I could have had strength to take medication if it was not prepacked in pill boxes for me.”

“Thank you for always encouraging me and always reminding me MDR-TB can be cured, I’m so glad I don’t have to take these pills anymore.”

The success of the DR-TB treatment adherence of the patients supported by the USAID TB LON-SAFT Programme’s adherence counsellors can be attributed to the development of the Adherence Information Booklet and pillboxes. These tools simplify dosing schedules and guide the patients on their road to recovery.

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