title: Prospective single-arm interventional pilot study to assess a smartphone-based system for measuring and supporting adherence to medication.
abstract: Suboptimal medication adherence for infectious diseases such as tuberculosis (TB) results in poor clinical outcomes and ongoing infectivity. Directly observed therapy (DOT) is now standard of care for TB treatment monitoring but has a number of limitations. We aimed to develop and evaluate a smartphone-based system to facilitate remotely observed therapy via transmission of videos rather than in-person observation.
  
  
  
  We developed an integrated smartphone and web-based system (Mobile Interactive Supervised Therapy, MIST) to provide regular medication reminders and facilitate video recording of pill ingestion at predetermined timings each day, for upload and later review by a healthcare worker. We evaluated the system in a single arm, prospective study of adherence to a dietary supplement. Healthy volunteers were recruited through an online portal. Entry criteria included age ≥21 and owning an iOS or Android-based device. Participants took a dietary supplement pill once, twice or three-times a day for 2 months. We instructed them to video each pill taking episode using the system.
  
  
  
  Adherence as measured by the smartphone system and by pill count.
  
  
  
  42 eligible participants were recruited (median age 24; 86% students). Videos were classified as received-confirmed pill intake (3475, 82.7% of the 4200 videos expected), received-uncertain pill intake (16, <1%), received-fake pill intake (31, <1%), not received-technical issues (223, 5.3%) or not received-assumed non-adherence (455, 10.8%). Overall median estimated participant adherence by MIST was 90.0%, similar to that obtained by pill count (93.8%). There was a good relationship between participant adherence as measured by MIST and by pill count (Spearmans rs0.66, p<0.001).
  
  
  
  We have demonstrated the feasibility, acceptability and accuracy of a smartphone-based adherence support and monitoring system. The system has the potential to supplement and support the provision of DOT for TB and also to improve adherence in other conditions such as HIV and hepatitis C.
authors.affiliation: University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: James S
authors.identifier: 0000-0002-2916-2818
authors.initials: JS
authors.lastname: Molton
authors.affiliation: University Medicine Cluster, National University Health System, Singapore, Singapore.
authors.forename: Yan
authors.initials: Y
authors.lastname: Pang
authors.affiliation: School of Computing, National University of Singapore, Singapore, Singapore.
authors.forename: Zhuochun
authors.initials: Z
authors.lastname: Wang
authors.affiliation: School of Computing, National University of Singapore, Singapore, Singapore.
authors.forename: Boqin
authors.initials: B
authors.lastname: Qiu
authors.affiliation: School of Computing, National University of Singapore, Singapore, Singapore.
authors.forename: Pei
authors.initials: P
authors.lastname: Wu
authors.affiliation: University Medicine Cluster, National University Health System, Singapore, Singapore.
authors.forename: Afifah
authors.initials: A
authors.lastname: Rahman-Shepherd
authors.affiliation: School of Computing, National University of Singapore, Singapore, Singapore.
authors.forename: Wei Tsang
authors.initials: WT
authors.lastname: Ooi
authors.affiliation: University Medicine Cluster, National University Health System, Singapore, Singapore.|Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
authors.forename: Nicholas I
authors.initials: NI
authors.lastname: Paton
mesh_terms: D000328:Adult; D023801:Directly Observed Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010865:Pilot Projects; D015397:Program Evaluation; D011446:Prospective Studies; D000068997:Smartphone; D017216:Telemedicine / Q000379:methods*; D014376:Tuberculosis / Q000188:drug therapy*; D055815:Young Adult
keywords: Directly Observed Therapy; Smartphone; adherence