How to Get TB Patients to Take Their Pills? Persistent Texting and a ‘Winners Circle’

Dr. Nazir Ismail, chief of tuberculosis research at the National Institute of Communicable Diseases in South Africa, also doubted that such significantly improved outcomes could be achieved in real-world use. He noted that the people enrolled in the study’s telephone program were, on average, somewhat better educated and more likely to speak English than those who were not enrolled.

Nonetheless, he said, “it does appear to be in principle a useful strategy.”

The expanded trial will look for ways to cut costs, Mr. Rathauser said. Right now, he must hire one “support sponsor” to send texts and make calls for each of the 2,000 patients; chatbots or other software might be able to take on some of the workload.

Adherence to medications is crucial in tuberculosis, because patients who miss too many pills often develop drug-resistant strains.

Recently, a powerful three-drug regimen was developed that can cure even extensively drug-resistant TB, the most lethal strain. But it still requires taking five drugs a day without fail for six months.

D.O.T. works quite well in highly regimented countries like Vietnam, where patients are hospitalized until they are no longer coughing up germs and, once they are allowed to go home, must report every day to one of the country’s 11,000 neighborhood health clinics and take their pills before a nurse.

But in countries like South Africa, D.O.T. is unworkable because it can take hours to reach a clinic. There also is ingrained resistance to blindly following government orders, because of decades of official abuse under apartheid, tuberculosis experts said.

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In the United States, tuberculosis is rare, but public health laws written in the 19th century give officials powerful tools for use when patients are uncooperative.