Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions
<jats:p> Problem definition: Lack of patient adherence to treatment protocols is a main barrier to reducing the global disease burden of tuberculosis (TB). We study the operational design of a treatment adherence support (TAS) platform that requires patients to verify their treatment adherence...
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| Format: | Article |
| Language: | English |
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Institute for Operations Research and the Management Sciences (INFORMS)
2022
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| Online Access: | https://hdl.handle.net/1721.1/145407 |
| _version_ | 1811089206881026048 |
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| author | Boutilier, Justin J Jónasson, Jónas Oddur Yoeli, Erez |
| author2 | Sloan School of Management |
| author_facet | Sloan School of Management Boutilier, Justin J Jónasson, Jónas Oddur Yoeli, Erez |
| author_sort | Boutilier, Justin J |
| collection | MIT |
| description | <jats:p> Problem definition: Lack of patient adherence to treatment protocols is a main barrier to reducing the global disease burden of tuberculosis (TB). We study the operational design of a treatment adherence support (TAS) platform that requires patients to verify their treatment adherence on a daily basis. Academic/practical relevance: Experimental results on the effectiveness of TAS programs have been mixed; and rigorous research is needed on how to structure these motivational programs, particularly in resource-limited settings. Our analysis establishes that patient engagement can be increased by personal sponsor outreach and that patient behavior data can be used to identify at-risk patients for targeted outreach. Methodology: We partner with a TB TAS provider and use data from a completed randomized controlled trial. We use administrative variation in the timing of peer sponsor outreach to evaluate the impact of personal messages on subsequent patient verification behavior. We then develop a rolling-horizon machine learning (ML) framework to generate dynamic risk predictions for patients enrolled on the platform. Results: We find that, on average, sponsor outreach to patients increases the odds ratio of next-day treatment adherence verification by 35%. Furthermore, patients’ prior verification behavior can be used to accurately predict short-term (treatment adherence verification) and long-term (successful treatment completion) outcomes. These results allow the provider to target and implement behavioral interventions to at-risk patients. Managerial implications: Our results indicate that, compared with a benchmark policy, the TAS platform could reach the same number of at-risk patients with 6%–40% less capacity, or reach 2%–20% more at-risk patients with the same capacity, by using various ML-based prioritization policies that leverage patient engagement data. Personal sponsor outreach to all patients is likely to be very costly, so targeted TAS may substantially improve the cost-effectiveness of TAS programs. </jats:p> |
| first_indexed | 2024-09-23T14:15:32Z |
| format | Article |
| id | mit-1721.1/145407 |
| institution | Massachusetts Institute of Technology |
| language | English |
| last_indexed | 2024-09-23T14:15:32Z |
| publishDate | 2022 |
| publisher | Institute for Operations Research and the Management Sciences (INFORMS) |
| record_format | dspace |
| spelling | mit-1721.1/1454072022-09-28T19:33:40Z Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions Boutilier, Justin J Jónasson, Jónas Oddur Yoeli, Erez Sloan School of Management <jats:p> Problem definition: Lack of patient adherence to treatment protocols is a main barrier to reducing the global disease burden of tuberculosis (TB). We study the operational design of a treatment adherence support (TAS) platform that requires patients to verify their treatment adherence on a daily basis. Academic/practical relevance: Experimental results on the effectiveness of TAS programs have been mixed; and rigorous research is needed on how to structure these motivational programs, particularly in resource-limited settings. Our analysis establishes that patient engagement can be increased by personal sponsor outreach and that patient behavior data can be used to identify at-risk patients for targeted outreach. Methodology: We partner with a TB TAS provider and use data from a completed randomized controlled trial. We use administrative variation in the timing of peer sponsor outreach to evaluate the impact of personal messages on subsequent patient verification behavior. We then develop a rolling-horizon machine learning (ML) framework to generate dynamic risk predictions for patients enrolled on the platform. Results: We find that, on average, sponsor outreach to patients increases the odds ratio of next-day treatment adherence verification by 35%. Furthermore, patients’ prior verification behavior can be used to accurately predict short-term (treatment adherence verification) and long-term (successful treatment completion) outcomes. These results allow the provider to target and implement behavioral interventions to at-risk patients. Managerial implications: Our results indicate that, compared with a benchmark policy, the TAS platform could reach the same number of at-risk patients with 6%–40% less capacity, or reach 2%–20% more at-risk patients with the same capacity, by using various ML-based prioritization policies that leverage patient engagement data. Personal sponsor outreach to all patients is likely to be very costly, so targeted TAS may substantially improve the cost-effectiveness of TAS programs. </jats:p> 2022-09-14T14:59:18Z 2022-09-14T14:59:18Z 2021 2022-09-14T14:54:15Z Article http://purl.org/eprint/type/JournalArticle https://hdl.handle.net/1721.1/145407 Boutilier, Justin J, Jónasson, Jónas Oddur and Yoeli, Erez. 2021. "Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions." Manufacturing and Service Operations Management. en 10.1287/MSOM.2021.1046 Manufacturing and Service Operations Management Creative Commons Attribution-Noncommercial-Share Alike http://creativecommons.org/licenses/by-nc-sa/4.0/ application/pdf Institute for Operations Research and the Management Sciences (INFORMS) Prof. Jonasson |
| spellingShingle | Boutilier, Justin J Jónasson, Jónas Oddur Yoeli, Erez Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions |
| title | Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions |
| title_full | Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions |
| title_fullStr | Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions |
| title_full_unstemmed | Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions |
| title_short | Improving Tuberculosis Treatment Adherence Support: The Case for Targeted Behavioral Interventions |
| title_sort | improving tuberculosis treatment adherence support the case for targeted behavioral interventions |
| url | https://hdl.handle.net/1721.1/145407 |
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