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Treatment adherence

TB pillbox reminders beat SMS for doses

Liu X, Lewis JJ, Zhang H, et al. · PLoS medicine · 2015

Open access · cc by · source: Europe PMC

In a China cluster RCT, medication-monitor reminders cut poor TB adherence 40–50%, while text messages mainly reduced loss to follow-up.

Study at a glance

Design
RCT — Cluster RCT across 36 sites: control, SMS, medication monitor, or combined
N
N=4173 · Pulmonary TB patients in China’s NTP
Population
Pulmonary tuberculosis patients in China’s National Tuberculosis Control Program
Outcome
Poor medication adherence and loss to follow-up

Structured fields used in claim comparison tables when every cited study has a complete layer.

Key findings

Medication monitors reduced poor adherence by 40–50% vs standard care; SMS alone did not improve adherence but cut loss to follow-up by 58%; 4,173 patients were analyzed.

Methodology

Across 36 clusters, investigators randomized pulmonary TB patients to control, SMS, medication monitor, or combined reminders and tracked missed doses and follow-up.

Limitations

Whether better adherence translates to microbiologic cure in this report, or how well monitors work outside China’s NTP.

How this study connects

Role on claims

Each row is a claim on a concept or method page where this paper supports, challenges, or qualifies the statement. Roles are hand-checked — not a model guess.

  • Across 36 clusters, 4,173 pulmonary TB patients were assigned to control, SMS, medication monitor, or both. Medication monitors reduced poor adherence by 40–50% versus standard care; SMS alone did not improve adherence but cut loss to follow-up by 58%. Better dose-taking in this report is not the same as proven microbiologic cure, and performance outside China's NTP is untested.

    Evidence for the claim as stated.

  • Process success and health success are not the same cluster-trial result. TSC moved toilets (~19 percentage points) without moving child health; TB medication monitors moved adherence 40–50% without, in this report, proving cure; SASA! moved IPV and concurrency by about 50% as the intended social outcome. A student who treats 'the cluster intervention worked' as one sentence will misread at least one of these papers.

    Evidence for the claim as stated.

Open questions

Tensions this paper is part of

From concept pages' “where studies disagree.” Disagreement means the same question; scope means different assays, populations, or outcomes.

  • Scope difference — different assays, populations, or outcomes

    Process success and health success are not the same cluster-trial result. TSC moved toilets (~19 percentage points) without moving child health; TB medication monitors moved adherence 40–50% without, in this report, proving cure; SASA! moved IPV and concurrency by about 50% as the intended social outcome. A student who treats 'the cluster intervention worked' as one sentence will misread at least one of these papers.

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Same topic cluster — not a recommendation engine.