Involving the actors in TB research: A necessary pathway to reach impact

Background: Tuberculosis (TB) is an urgent global health threat and the world’s deadliest infectious disease despite being largely curable. A critical challenge is to ensure that patients adhere to the full course of treatment to prevent the continued spread of the disease and development of drug-resistant disease. Setting up local research agendas for the generation, translation, and dissemination of knowledge is a priority. As local resources were scarce, during the last 10 years IECS promoted an initiative to seek funding and collaborations to start a line of research on patient and system factors associated with successful treatment of TB directly involving patients, health personnel and managers of TB programs. 

Objective: To describe this strategy to support adherence and improve TB treatment outcomes in Argentina.  

Methods and results: In 2011, a 3-year NIH grant allowed us to conduct quantitative and qualitative studies to evaluate individual and health system barriers to achieve treatment success. Findings of these studies showed the benefit of measures other than supervision (DOT), such as social protection and cash transfer programs and alternative means of treatment support. In 2013 we ran a first pilot study on the use of SMS and in 2017, another pilot study to develop a smartphone web app to enhance adherence for patients on self-administered treatment. In 2019, we obtained a new grant to start a pragmatic clinical trial to evaluate the effectiveness of TB treatment support tools (TB-TSTs) using the app to report self-administering medication, potential side effects and interact with a treatment supporter as needed. 

Comment: All these studies actively engaged patients, families, health care teams and TB program staff to assess experiences and perspectives of the facilitating and challenging factors at the individual, structural, social, and organizational levels. Adherence is not a free choice but rather a reflection of behaviors conditioned by the health, sociocultural and economic environments. To make substantive changes in countries where treatment success is consistently low and drug resistance is increasing, the identification of root causes in the local contexts is essential and active involvement of the actors in the process is vital.